This study aimed to evaluate the predictive value of both hearing level (at various frequencies) and speech discrimination for forecasting hearing outcome after a period of observation, in patients with vestibular schwannoma.

Over a 33-year period, 1144 patients with vestibular schwannoma were allocated to ‘wait and scan’ management, with annual magnetic resonance imaging and audiological examination. Two complete pure tone and speech discrimination audiograms were available for 932 patients.

The predictive value of initial hearing level better than 10 dB for forecasting hearing outcome after observation increased from 59 per cent at 250 Hz to 94 percent at 4000 Hz. At diagnosis, hearing level of 10 dB or better at 4000 Hz was found in only 18 of the 932 VS ears, while good speech discrimination was found in 159 patients (17 per cent). Of the latter patients, 138 maintained good hearing after observation.

In vestibular schwannoma patients, good high frequency hearing and good speech discrimination at diagnosis are useful tools in predicting good hearing after observation.

Parotidectomy in children is uncommon, and surgeons face specific challenges not encountered in adult practice.

Retrospective review of parotidectomies performed in our paediatric hospital over a 10-year period (1999–2008).

Twenty-one children underwent 22 parotidectomies, of which six were total. The following pathology was encountered: atypical mycobacterial infection (8.38 per cent), pleomorphic adenoma (4.19 per cent), lymphatic malformation (2.10 per cent), haemangioma (2 per cent), first branchial cleft anomaly (2 per cent), follicular non-Hodgkin's lymphoma (2 per cent) and lipoblastoma (1.5 per cent). No cases of permanent facial nerve palsy occurred. Mild transient facial nerve palsy occurred in five patients (23 per cent), gustatory sweating in four (19 per cent) and hypertrophic scarring in three (14 per cent).

We discuss the range of parotid pathology found in children, the approach to investigation, the surgical difficulties encountered, and ways to reduce the apparently higher rate of complications encountered. Parotid surgery in children should be concentrated in the hands of a small number of surgeons with a particular interest in this area.

To present the current treatment approach for oroantral fistula causing maxillary sinusitis.

Case series. Four cases of oroantral fistula (diameters: 6, 9, 11 and 13 mm) due to chronic maxillary sinusitis were treated by excision of all diseased oroantral fistula tissue, followed by endoscopic creation of a large middle antrostomy and closure of the fistula using buccal flaps. A synthetic surgical glue and local alveolar bone were used.

Patients were followed up for six months to three years; all were considered cured.

Most surgeons use buccal or palatal flaps, combined with the Caldwell–Luc procedure, to treat chronic odontogenic sinusitis and to repair fistulae more than 5 mm in diameter. This study supports the hypothesis that an endoscopic technique could be successfully used in patients with oroantral fistula causing chronic maxillary sinusitis of dental origin, instead of the Caldwell–Luc procedure, at least in patients with a small to medium-sized oroantral fistula.

This study aimed to evaluate the presence of reactive oxygen species in laryngeal cancer tissue, using a luminol-amplified chemiluminescence method.

Fourteen patients with histopathologically diagnosed laryngeal squamous cell carcinoma were enrolled. Patients with recurrent tumours or a history of prior chemotherapy or radiotherapy were excluded. Tissue specimens were harvested both from the tumour itself and from the neighbouring, apparently normal mucosa (immediately after tumour removal). Tissue specimens were washed with ice-cold saline solution and processed immediately, without storage. The level of reactive oxygen species was measured quantitatively by a luminol-amplified chemiluminescence method.

The mean luminol-amplified chemiluminescence values for tumour and control tissue were 140.52 (standard error of the mean 40.21) and 121.36 (standard error of the mean 35.33) relative light units/mg tissue, respectively. Furthermore, mean tumour and control luminol chemiluminescence values were compared for stage one and two tumours versus stage three and four tumours. Both the tumour and the control luminol chemiluminescence values for the latter tumour group were significantly higher than those for the former tumour group.

This study measured directly the levels of reactive oxygen species in samples of laryngeal cancer tissue and normal mucosa. Higher levels of reactive oxygen species were found in laryngeal cancer tissue, suggesting a relationship between reactive oxygen species and laryngeal cancer.

This study aimed to investigate the utility of three-dimensional reconstructions of paranasal sinus computed tomography data in depicting the anatomy of the frontal sinus drainage pathway.

Twenty-nine patients underwent imaging of the sinuses for various clinical indications. Variations in frontal sinus recess anatomy were determined from 0.75-mm thick coronal, axial and sagittal computed tomography images. Three-dimensional, reformatted images were generated from manually segmented volumes of interest. Observations were made on the variation and usefulness of these reconstructions.

Three-dimensional, reformatted images of segmented volumes aided delineation of the spatial relationships of the frontal sinus, frontal sinus drainage pathway, infundibular and meatal direction of drainage, agger nasi cells, ethmoid bulla cells, supraorbital cells, and suprabullar cells.

Three-dimensional, reformatted images of frontonasal anatomy enable improved understanding of the frontal sinus drainage pathway anatomy and of the spatial relationships between ethmoid air cells in this region. Such images may provide a useful adjunct to surgical planning and education.

To investigate the effect of the HuR gene on laryngeal carcinoma Hep-2 cell growth, and to analyse correlations between the HuR, cyclooxygenase-2 and survivin genes.

Experiment study.

Department of Otolaryngology-Head and Neck Surgery, Lihuili Hospital of Ningbo University, Ningbo, a tertiary care centre in China.

Copies of a small interfering RNA segment directed against the HuR gene were transfected into Hep-2 cells using LipofectamineTM 2000. The effect of the small interfering RNA segment on Hep-2 cell proliferation was determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Changes in the expression of the HuR, cyclooxygenase-2 and survivin genes were detected by semi-quantitative reverse transcription polymerase chain reaction analysis. Concentrations of the HuR, cyclooxygenase-2 and survivin proteins were evaluated using Western blotting.

Expression of the HuR, cyclooxygenase-2 and survivin genes, as indicated by messenger RNA and protein levels, was suppressed by the HuR gene small interfering RNA segment in a dose-dependent manner. The proliferation indices of all treated groups were significanlty lower than those of control groups (p < 0.05).

Impairment of HuR gene expression, using interfering RNA technology, can significantly suppress Hep-2 cell proliferation and induce apoptosis. The HuR gene may be an effective target for gene therapy in patients with laryngeal carcinoma.

The canal wall up bony obliteration technique lowers the incidence of recurrent cholesteatoma, but carries the potential risk of obliterating residual cholesteatoma. The objective of this study was to report long-term follow-up radiological findings after performing a canal wall up bony obliteration technique procedure, in order to detect residual and/or recurrent cholesteatoma.

Fifty-one patients presenting with a cholesteatoma or a troublesome cavity were operated upon using the canal wall up bony obliteration technique, and were evaluated by follow-up imaging a mean of 76.4 months post-operatively (range, 53.8–113.6 months).

All patients were evaluated with high resolution computed tomography and magnetic resonance imaging (including delayed contrast, T1-weighted imaging and non-echo-planar, diffusion-weighted imaging).

Imaging revealed the presence of one residual, one recurrent and one congenital petrosal apex cholesteatoma. On high resolution computed tomography, completely obliterated mastoid filled with bone was observed in 74.5 per cent (38/51) of patients, and an aerated middle-ear cavity in 64.7 per cent (33/51). High resolution computed tomography clearly detected any associated soft tissue present in the middle-ear cavity (18/51) and in the obliterated mastoids (13/51), but could not characterise this tissue. Non-echo-planar, diffusion-weighted magnetic resonance imaging clearly identified all three cholesteatomas, and differentiated them from other associated soft tissues. No cholesteatoma was found within the obliterated mastoids.

Long-term follow up indicated that the canal wall up bony obliteration technique is a safe method with which to treat primary and recurrent cholesteatoma and to reconstruct unstable cavities. Soft tissue was found quite often in the middle ear and obliterated mastoids. High resolution computed tomography identified its presence but could not further characterise it. However, non-echo-planar, diffusion-weighted magnetic resonance imaging succeeded in differentiating soft tissues, enabling detection of residual or recurrent cholesteatoma after a canal wall up bony obliteration technique procedure.

To determine the effect of embolisation on endoscopic resection of angiofibroma.

A partially blinded trial was undertaken. Twenty-three patients with angiofibroma (nine embolised and 14 not embolised) underwent endoscopic resection between January 2007 and August 2008 in two tertiary referral centres. Demographic data were collected, the pre-operative tumour extent was assessed by computed tomography, and tumours were staged according to their computed tomography appearance (Radkowski scale). In addition, we evaluated the duration of surgery, amount of haemorrhage, blood pressure during surgery, duration of hospitalisation, complications of surgery and embolisation, cost of treatment, and number of post-operative recurrences, as well as the angiographic characteristics in the embolisation group.

There was no significant difference between the general characteristics of both groups. At the end of the study period, we could find no significant difference between the two groups regarding haemorrhage, number of recurrences or complications. The only significant difference was cost of treatment, which was significantly higher in the embolisation group.

Endoscopic resection is a feasible and safe method for angiofibroma surgery. The current evidence does not support obligatory embolisation in every case of endoscopic angiofibroma resection.

Many patients with allergic rhinitis are reluctant to use daily intranasal steroids for prolonged periods. A self-adjusted regimen which delivers reasonable control of allergic rhinitis may be more acceptable to such patients.

To compare the efficacy of daily use of mometasone furoate nasal spray, versus a self-adjusted regimen, in patients with chronic allergic rhinitis, in terms of symptom control and nasal volume change.

Ambulatory visits in an office setting.

Sixty patients with chronic allergic rhinitis were randomised: 30 were prescribed mometasone furoate nasal spray once daily for six weeks, while 30 were prescribed the same spray daily for one week, every alternate day for one week and then on a self-adjusted regimen for four weeks. Patients kept a symptom diary documenting sneezing, rhinorrhoea, nasal blockage and nasal itching. Acoustic rhinometry was used to measure the total nasal cavity volume at the first visit and at the end of the treatment period.

The total nasal score on treatment days showed an improvement in both groups, compared with baseline measurements. There was no significant difference in total nasal scores between the two groups, except on days 10 (p = 0.043), 20 (p = 0.008), 23 (p = 0.19), 30 (p = 0.008) and 37 (p = 0.000), when the daily group's total nasal score was significantly lower than the self-adjusted group's total nasal score, and on day 8 (p = 0.004), when the self-adjusted group's total nasal score was significantly lower than the daily group's total nasal score. Total nasal cavity volume significantly increased in both groups (p = 0.0001), with no statistically significant difference between the groups.

Self-adjusted dosage of mometasone furoate nasal spray gives reasonable control of allergic rhinitis (albeit with some ‘breakthrough’ symptoms). Patients should learn how to control these symptoms with the least number of steroid doses.

Bacterial biofilms have been implicated in the pathogenesis of chronic rhinosinusitis. In the laboratory setting, ultrasound is effective in disrupting such biofilms; however, few clinical studies have evaluated the role of therapeutic ultrasound in chronic rhinosinusitis.

This study was performed to investigate the short-term effectiveness of therapeutic ultrasound as a treatment modality for chronic rhinosinusitis.

Twenty-two patients with a positive history of chronic rhinosinusitis, according to the criteria set out by the Rhinosinusitis Task Force, together with a previous computed tomography scan compatible with a diagnosis of chronic rhinosinusitis, and who had failed previous, aggressive medical management, were treated with therapeutic pulsed ultrasound at 1 MHz two to three days per week for six sessions. Patients completed an assessment of individual sinus symptom severity and the 20-Item Sino-Nasal Outcome Test questionnaire before treatment, prior to session four and after completion of session six.

Two patients were unable to complete the study protocol. After completion of session six, 18 patients had experienced improvement in symptoms, while two patients noted a worsening of symptoms. Median percentage improvement of the total overall symptom score was 16.7 per cent (Wilcoxon signed rank, p < 0.001). The 20-Item Sino-Nasal Outcome Test score improved by 34.1 per cent (Wilcoxon signed rank, p < 0.0001).

This study demonstrated a significant improvement in chronic rhinosinusitis symptoms after a six-session course of pulsed ultrasound therapy. Treatment with ultrasound alone or combined with antibiotics may provide a strategy to target biofilms on the sinus mucosa. Therapeutic ultrasound warrants further investigation as a potential treatment modality for chronic rhinosinusitis.

Virtual bronchoscopy is a noninvasive technique which provides an intraluminal view of the tracheobronchial tree. This study aimed to evaluate this technique in comparison with rigid bronchoscopy, in paediatric patients with tracheobronchial foreign bodies undetected by plain chest radiography.

Plain chest radiography was initially performed in 40 children with suspected foreign body aspiration. Computed tomography virtual bronchoscopy was performed in the 20 in whom chest radiography appeared normal. Virtual bronchoscopic images were obtained. All patients underwent rigid bronchoscopy performed by an otolaryngologist blinded to the computed tomography virtual bronchoscopy findings, within 24 hours. Virtual bronchoscopic findings were then compared with the results of rigid bronchoscopy.

In 12 patients, foreign bodies detected by virtual bronchoscopy were confirmed by rigid bronchoscopy. In one case, a mucous plug was perceived as a foreign body on virtual bronchoscopy. In another case, a minute foreign body was missed on virtual bronchoscopy. The following parameters were calculated: sensitivity, 92.3 per cent; specificity, 85.7 per cent; validity, 90 per cent; positive likelihood ratio, 6.45; and negative likelihood ratio, 0.089.

In the presence of a positive clinical diagnosis and negative chest radiography, computed tomography virtual bronchoscopy must be considered in all cases of tracheobronchial foreign body aspiration, in order to avoid needless rigid bronchoscopy. Computed tomography virtual bronchoscopy is particularly useful in screening cases of occult foreign body aspiration, as it has high sensitivity, specificity and validity.

To determine the accuracy of fine needle aspiration cytology conducted within a standard ENT out-patients service (rather than a one-stop neck lump clinic), and also to assess the value of ultrasound guidance during fine needle aspiration cytology.

Retrospective study of all patients undergoing fine needle aspiration cytology of a neck lump, from 2005 to 2008 in Leeds teaching hospitals.

Accuracy of fine needle aspiration cytology, compared with the corresponding histology report of the original surgical specimen, and non-diagnostic fine needle aspiration cytology rates with and without ultrasound.

Fine needle aspiration cytology yielded the following respective sensitivity, specificity and accuracy rates: 85, 91 and 87 per cent for lymph nodes; 80, 93 and 89 for salivary glands; and 52, 80 and 69 for thyroid. The proportion of non-diagnostic procedures was 28 per cent, both with and without ultrasound guidance.

Cytologist-led fine needle aspiration cytology would have reduced the time to diagnosis and the number of clinic visits per patient. Fine needle aspiration cytology was accurate for predicting malignancy in salivary gland and lymph node lesions, and for diagnosing lymph node pathology. Study results did not support the use of ultrasound guidance during fine needle aspiration cytology.

Allergic fungal rhinosinusitis is a benign, noninvasive sinus disease related to hypersensitivity to fungal infection having bony skull base and orbital erosion as common finding.

This descriptive study was conducted at the department of otorhinolaryngology, Dow University of Health Sciences, Karachi, Pakistan, from April 2003 to March 2006. In forty-seven proven cases of allergic fungal sinusitis the following information was recorded: demographic data, signs and symptoms, laboratory investigation results, imaging results, pre- and post-operative medical treatment, surgery performed, follow up, and residual or recurrent disease. The Statistical Package for the Social Sciences version 10.0 software was used for data analysis.

Findings indicated that allergic fungal rhinosinusitis usually occurred in the second decade of life (51.06 per cent) in males (70.21 per cent), allergic rhinitis (100 per cent) and nasal polyposis (100 per cent). Nasal obstruction (100 per cent), nasal discharge (89.36 per cent), postnasal drip (89.36 per cent), and unilateral nasal and paranasal sinus involvement (59.57 per cent) were significant features. Aspergillus (59.57 per cent) was the most common aetiological agent. Combined orbital and skull base erosion was seen in 30.04 per cent of cases, with male preponderance 6.8:1. Endoscopic sinus surgery was performed in all cases, and recurrent or residual disease was observed in 19.14 per cent.

Allergic fungal rhinosinusitis is a disease of young, immunocompetent individual. Skull base and orbital erosion are seen in one-third of cases. Bone erosion is 6.8 times more common in males than females. Orbital erosion is 1.5 times more common than skull base erosion. Endoscopic surgical debridement and drainage combined with topical steroids leads to resolution of disease in the majority of cases, without resorting to systemic antifungal agents, craniotomy or dural resection.

To test the association between clinical allergic sensitisation to pollens and the profile and load of those pollens, in Ankara, Turkey.

Forty-three patients with seasonal allergic rhinitis were included. Clinical sensitisation to various pollens was compared with 10-year counts of the same pollens. The ratios of sensitisation to various pollen groups, and the association between clinical sensitisation and pollen load, were investigated.

Grass pollen allergy was the leading cause of seasonal allergic rhinitis, followed by tree pollen allergy. In Ankara, the most common type of airborne tree pollen was salicacea; however, the commonest clinical tree pollen allergies were due to the betulaceae and fagaceae families.

Higher concentrations of airborne pollens may not always result in a higher prevalence of clinical allergy to those pollens.

To compare the results of radiofrequency thermal ablation versus ‘cold steel’ excision, for supra-auricular excision of preauricular sinus.

Prospective study. Observations included recurrence, intra-operative bleeding, operation time and ease of dissection.

Tertiary referral hospital.

Sixty cases of preauricular sinus were assigned randomly to two groups (30 cases each). Group one patients underwent cold steel sinus excision, whereas group two patients underwent radiofrequency-assisted sinus excision.

Fifty patients were operated upon, with a mean age of 12.26 years. Most patients were aged between zero and five years (40 per cent). The average patient follow-up time was 15 months (range, six to 24 months). Recurrence rates were 23 per cent in group one and 3 per cent in group two; this difference was statistically significant (p = 0.016). Dissection of the sinus tract was reported to be much easier in the radiofrequency group, compared with the cold steel group (p = 0.023), with minimal bleeding.

From our observations, radiofrequency-assisted, local, wide excision appears to be preferable for treatment of preauricular sinus, compared with cold steel excision, as it allows better peri-operative visualisation, easier dissection, minimal bleeding and a lower subsequent recurrence rate (3.3 per cent).

To determine the effect on patients' quality of life of functional endoscopic sinus surgery performed for chronic rhinosinusitis within a tertiary care centre in Montreal, Canada.

A prospective cohort study was undertaken. Subjects were consecutive patients with a diagnosis of chronic rhinosinusitis who had failed medical treatment and were undergoing functional endoscopic sinus surgery. Questionnaires assessing general health outcomes (i.e. the second version of the Short Form 12 questionnaire) and disease-specific outcomes (i.e. the Chronic Sinusitis Survey) were completed pre-operatively and a minimum of three months post-operatively.

A total of 152 patients were enrolled over a seven-month period, of whom 120 completed the post-operative surveys. The most common co-morbidity was asthma (40 per cent). Of the 120 patients with completed questionnaires, 72 per cent reported clinical improvement, 12 per cent reported deterioration and 15 per cent remained unchanged. The average improvement in Chronic Sinusitis Survey score was 17 per cent.

Patients with chronic rhinosinusitis achieved a significant improvement in disease-specific quality of life after functional endoscopic sinus surgery. There was no significant improvement in general health related quality of life, as measured using the Short Form 12 questionnaire.

To audit the management of periorbital cellulitis or abscess, in line with guidelines published in 2004, within a district general hospital and a tertiary referral centre.

Retrospective audit analysing 58 cases at a district general hospital and 61 cases at a tertiary referral centre, encountered since 2004.

At the tertiary referral centre, 22 patients were diagnosed with pre-septal cellulitis and discharged, as were 20 cases at the district general hospital. At the tertiary referral centre, 95 per cent of patients were correctly seen by an ophthalmologist and 82 per cent by a senior ENT surgeon, compared with 63 and 39 per cent, respectively, at the district general hospital. In both centres, one patient did not receive a computed tomography scan where this was indicated. Despite the need for twice daily monitoring of ophthalmological criteria, both sites lacked 100 per cent compliance. At the tertiary referral centre, 76 per cent of patients were correctly treated with intravenous antibiotics, compared with 68 per cent at the district general hospital.

At both sites, adherence to guidelines was suboptimal. Management may be improved through improved education and online information support.

Some researchers have suggested that Epstein–Barr virus may play a role in the pathogenesis of laryngeal malignancies. In order to clarify the role of cytokines in this disease context, the current study aimed to determine the serum levels of cytokines in Epstein–Barr virus DNA positive patients with laryngeal carcinoma.

The study included 10 patients with diagnosed laryngeal carcinoma and Epstein–Barr virus DNA positive tumour tissue samples. The control group comprised 10 Epstein–Barr virus DNA negative patients diagnosed with laryngeal carcinoma, 10 patients with acute Epstein–Barr virus infection and 10 healthy individuals.

Serum cytokine levels were determined by enzyme-linked immunosorbent assay.

The Epstein–Barr virus DNA positive and negative laryngeal carcinoma patients showed no differences regarding serum levels of the following cytokines: interleukins 1β, 2, 6 and 12, tumour necrosis factor α, and interferon γ. However, serum levels of interleukin 10 and transforming growth factor β1 were significantly higher in Epstein–Barr virus DNA positive laryngeal carcinoma patients compared with Epstein–Barr virus DNA negative laryngeal carcinoma patients (p < 0.05).

Our results suggest that the cytokines interleukin 10 and transforming growth factor β1 may act as growth factors in Epstein–Barr virus related laryngeal carcinoma. These cytokines may thus represent potential targets for molecular therapeutic treatment for laryngeal carcinoma; they may also be useful as indicators of disease prognosis.

To present our experience in managing cerebrospinal fluid rhinorrhoea using the cartilage inlay (underlay) technique to repair skull base defects larger than 4 mm.

Retrospective study involving patients presenting with cerebrospinal fluid rhinorrhoea between 1994 and 2008.

Patients were treated in a tertiary referral centre for nose and sinus diseases. Patients' medical records were reviewed and analysed.

A total of 62 patients were operated upon using a cartilage inlay technique to repair bony skull base defects ranging in size from 4 to 20 mm (widest diameter). Of these 62 patients, 16 constituted revisions of earlier procedures undertaken elsewhere. The success rate of the technique was 100 per cent. Patient follow up ranged from six months to 16 years, with a median follow up of 15 months. Three patients had minor post-operative sinus infections; no serious complications were encountered.

Extradural cartilage inlay appears to be an effective technique in the management of cerebrospinal fluid rhinorrhoea, especially for large defects and revision procedures. To our knowledge, the described patients represent the largest reported series of cerebrospinal fluid rhinorrhoea cases managed using the cartilage inlay technique. We believe that the crucial factors in our high success rate for cerebrospinal fluid fistula repair are: precise identification of the bony defect; meticulous preparation of the graft bed; careful elevation of the dura; judicious use of just enough graft tissue; and adequate graft support.

Sphenoid sinus mucoceles represent only 1–2 per cent of all paranasal sinus mucoceles. Patients may present with a myriad of symptoms. Pre-operative investigations include nasoendoscopy, computed tomography and/or magnetic resonance imaging. Treatment is by endoscopic sinus surgery.

A retrospective review of the archives of the Singapore General Hospital otolaryngology department (1999–2006) identified 10 cases of sphenoid sinus mucocele. Patient demographics, presenting symptoms, investigations and treatment were evaluated.

The 10 patients identified (three women and seven men) had a mean age of 54.5 years (range 24–70 years). Thirty per cent of patients had a history of nasopharyngeal carcinoma treated with radiotherapy. Presenting symptoms, in order of decreasing frequency, were: ocular symptoms (50 per cent), headaches (30 per cent), nasal discharge (30 per cent) and facial pain (10 per cent). All patients underwent pre-operative computed tomography or magnetic resonance imaging. Twenty per cent of patients had evidence of intracranial involvement on imaging. All patients underwent uncomplicated transnasal sphenoidotomy and drainage of the mucocele. There was no clinical or radiological evidence of recurrence at a mean follow up of 29 months (range 4–90 months).

Sphenoid sinus mucocele is a rare condition. In this study, radiation to the head and neck appeared to be a predisposing factor, and eye symptoms were the commonest presentation. Endoscopic sinus surgery is a safe and effective treatment modality.