We report a young man with bilateral enlarged internal auditory canals who developed sudden sensorineural hearing loss following weight-lifting exercise.

We present a detailed clinical history, including the patient's high resolution computed tomography and magnetic resonance imaging scans.

The patient reported left-sided hearing loss immediately following weight-lifting exercise. He had no vestibular disturbance. He was treated with a combined regimen of steroids and an antiviral drug, but his profound hearing loss did not resolve. During another session of weight-lifting exercise, he suffered another episode of sudden hearing loss.

To the best of our knowledge, this is the first report of a patient with patulous internal auditory canals, with no other anomalies, who developed bilateral sudden hearing loss after weight-lifting exercise. Although no definitive conclusions can be drawn, close surveillance and lifestyle warnings should be considered in such patients, even if they are clinically asymptomatic.

Vagus nerve stimulators are devices used in the management of patients with drug-refractory epilepsy unsuitable for resective or disconnective surgery. Implanted usually by neurosurgeons, these devices are infrequently encountered by otolaryngologists. Despite significant anti-seizure efficacy, side effects related to laryngopharyngeal stimulation are not uncommon.

A 28-year-old man with a history of effective vagus nerve stimulator use presented with a cluster of seizures and respiratory distress associated with intermittent stridor. The duration of stridor corresponded to the period of vagus nerve stimulation. Endoscopy revealed forced adduction of the left vocal fold against a medialised right vocal fold. The device was switched off and the stridor immediately resolved.

Airway compromise is an under-recognised side effect of vagus nerve stimulation. We describe the first known case of stridor and contralateral vocal fold palsy in a vagus nerve stimulator user. We highlight the need for better understanding amongst otolaryngologists of the laryngopharyngeal side effects of this technology.

The prevalence of eosinophilic oesophagitis is increasing. A Pubmed search for ‘eosinophilic oesophagitis’ and ‘eosinophilic esophagitis’ yielded 345 publications since 1976. Only seven were in otolaryngology journals.1–7 Patients typically present with dysphagia, vomiting, dyspepsia or food impaction and are therefore usually referred to a paediatric gastroenterologist; otolaryngologists are not usually involved in management. A missed diagnosis may result in oesophageal stricture.

Two patients, aged two and four years, were referred to the paediatric otolaryngology department with intermittent upper oesophageal food impaction. A paediatric gastroenterologist was involved in the investigation. Histological examination of oesophageal biopsies demonstrated changes consistent with eosinophilic oesophagitis.

Both patients were expediently diagnosed, investigated and managed.

A diagnosis of eosinophilic oesophagitis must be considered in patients presenting with food bolus impaction. Early involvement of a paediatric gastroenterology team in the diagnosis is recommended in children presenting with oesophageal symptoms, in order to avoid delayed diagnosis.

Inverted papilloma is a rare but locally aggressive tumour with the potential for malignant transformation. Intracranial extension or complications secondary to inverted papilloma are extremely rare. We report a case of inverted papilloma with a large frontal sinus mucocele eroding the frontal sinus, which presented with sudden neurological compromise. A literature review on intracranial extension of such tumours is also included.

A Medline search of articles, using the terms ‘inverted papilloma’, ‘Ringertz tumour’, ‘intracranial extension’ and ‘complication’. Suitable references from the collected articles were also reviewed. Articles published in English were selected and reviewed.

A total of 10 cases was identified. Intracranial spread was more commonly seen in recurrent cases, especially if the recurrence involved the cribriform plate, fovea ethmoidalis or orbits. Cases with extradural disease seemed to have a better prognosis than those with intradural spread.

Intracranial involvement of inverted papilloma is extremely rare, and is usually seen in recurrent cases. This case report highlights an unusual but serious case of inverted papilloma presenting with acute neurological deterioration secondary to a large frontal sinus mucocele eroding the frontal sinus. A literature review on intracranial extension of inverted papilloma indicated that common sites of intracranial spread include the cribriform plate, fovea ethmoidalis and orbits. The prognosis for patients with such tumours depends on the type of dural involvement, with intradural extension carrying a poorer prognosis.

We report the first case of a laryngeal composite tumour consisting of a squamous cell carcinoma combined with an atypical carcinoid.

Case report and review of the literature concerning laryngeal composite tumours.

Primary laryngeal carcinoma is the most common malignancy of the upper aerodigestive tract. The vast majority are of the squamous cell type. Primary neuroendocrine neoplasms represent a rare, heterogeneous subset of laryngeal malignancies, comprising typical carcinoid, atypical carcinoid, small cell carcinoma and paraganglioma. Primary combined neuroendocrine and squamous cell carcinoma of the larynx is even more rarely encountered, with only 14 publications of this so-called composite tumour to date. In each case, the neuroendocrine component has been small cell carcinoma.

The treatment of primary neoplasms comprising more than one histological type is tailored to the most biologically aggressive tumour. Accurate diagnosis of the histological nature of laryngeal composite tumours is imperative to ensure optimal therapy.

We report a case of spontaneous tonsillar haemorrhage due to underlying von Willebrand's disease, without symptoms or signs of infection.

Case report and literature review of reported causes of spontaneous tonsillar haemorrhage.

Spontaneous tonsillar haemorrhage is uncommon. Acute bacterial tonsillitis, peri-tonsillar abscess, infectious mononucleosis and idiopathic causes have been reported. Two cases of tonsillitis with underlying bleeding disorders have been reported. We present the first reported case of spontaneous tonsillar haemorrhage secondary to von Willebrand's disease, without evidence of tonsillitis.

Spontaneous tonsillar haemorrhage is usually related to infection of the tonsils or peri-tonsillar space. An underlying bleeding disorder should be suspected if no evidence of infection is found.

To report the coexistence of multiple tegmen defects, forming a ‘honeycomb’ pattern, together with dehiscence of the superior semicircular canal.

We describe three cases in which the above findings were noted, and we review the relevant literature.

Superior semicircular canal dehiscence is defined as the absence of portions of bone over the canal along the floor of the middle fossa. Most published articles describe the defect as an isolated finding which is either unilateral or bilateral. Studies on temporal bones show either a defect over the superior semicircular canal or isolated defects over the tegmen. We describe three cases in which we found multiple tegmen defects, giving a characteristic honeycomb appearance, coexisting with dehiscence over the superior semicircular canal. This finding, which supports the theory of a developmental defect as the origin of the condition, has not previously been reported. A literature review is presented, with discussion of the aetiology and management of superior semicircular canal dehiscence.

We report a rare case of a 51-year-old woman with ocular and nasal infestation by Oestrus ovis.

Clinical case report and review of current literature regarding nasal and ophthalmomyiasis.

Myiasis is infestation of the tissues and organs of vertebrates by certain dipteran fly larvae. Oestrus ovis myiasis is endemic in the region from North Africa to South Asia, but few cases are reported within the UK. A 51-year-old patient presented and was treated successfully in Sunderland Royal Hospital for combined ocular and nasal infestation with Oestrus ovis.

Oestrus ovis has a largely subtropical distribution; however, it is important to remember the diversity of disease which can present within the UK from an external source. This point is illustrated by this rare case, which highlights the fact that prompt treatment can avoid poor outcomes for our patients.