During cochlear implantation, precise placement of the cochlear electrodes against the cochlear nerve is one of the most important steps, necessary to enable the patient to be aware of the stimulus from the implanted device. Neural response imaging (NRI) is a new tool which measures the evoked compound action potential generated as a result of electrical stimulation of the cochlea by properly placed electrodes during surgery.

The aim of this study was to examine the correlation between intra-operative NRI recordings and ‘most comfortable levels’ (M levels) measured during standard fitting with the SoundWave fitting software, in cochlear implantation patients. Seven adult subjects were included in the study. The average duration of profound bilateral deafness was seven years (range = 19 years) and the mean age at implantation was 24 years (range = 17–34 years). All subjects underwent implantation and reached the one-month fitting session; one patient reached the two-month fitting session. The intra-operative NRI threshold (tNRI) was observed to be much higher than the first fitting M levels. The tNRI was 203 per cent of the sequential M value and 246 per cent of the paired M value. All but one intra-operative tNRI values were greater than 150 clinical units (CU), and all first fitting M levels were on average below 100 CU. No obvious correlation was found between individual intra-operative tNRI and first fitting M levels. The M levels at one month were much higher than the first fitting M levels, with much more dispersion.

Aim: To investigate the prevalence of tinnitus and deafness in subjects with Paget's disease of bone.

Materials and methods: One hundred and thirty-four subjects in total (77 with Paget's disease) were identified and audiologically examined. Subjects' experience of tinnitus was surveyed via a questionnaire and the results compared with those of age-matched controls.

Results: Hearing loss in those with Paget's disease of bone was significantly worse than in controls. Hearing handicap was also much worse in the Paget's subjects. Sixty-one per cent of the Paget's subjects suffered from tinnitus, compared with 36 per cent of the controls.

Conclusion: Deafness is a recognized, common sequelae of Paget's disease of bone, and tinnitus is a common accompanying symptom.

Neurogenic tumours form a very small percentage of all neoplastic lesions of the head and neck region. However, the head and neck region is by far the most common location for benign peripheral nerve tumours. Several cases involving the nose have been sporadically documented throughout the medical literature.

We present a rare case of a solitary neurofibroma arising from the lateral nasal wall of a 68-year-old woman. En bloc surgical resection of the mass was achieved by the lateral rhinotomy approach.

The clinical significance of this case report is due to its rare site. In recent medical literature, there has been only one report concerning a solitary neurofibroma arising from the inferior turbinate. This case also highlights the importance of considering this clinical entity in the differential diagnosis when encountering a unilateral soft tissue mass in the nasal cavity.

There is marked diversity in the reported success rates for achieving an intact tympanic membrane following myringoplasty. Controversy exists about the factors thought to influence surgical outcome. Both of these facts have important implications for obtaining informed consent prior to surgery.

This study reviews the factors thought to determine the likelihood of achieving complete closure of the tympanic membrane following surgical closure.

Antibiotic-resistant bacteria are increasingly common and present a major problem for the modern day ENT surgeon. This article reviews the development of methicillin resistance in Staphylococcus aureus and how it has come to affect ENT practice. We look at the evidence behind measures taken to help deal with methicillin-resistant Staphylococcus aureus (MRSA) and to prevent its spread. We go on to suggest a departmental guideline for infection control, which we hope can be implemented to help deal with the problems created by MRSA.

Low-frequency hearing impairment (LFHI) is mainly attributed to endolymphatic hydrops and has a great variety of possible outcomes. At present, no conservative therapeutic regimen has proven to be ‘gold-standard’, and information about the prognostic indicators of LFHI is scarce.

In a retrospective investigation, we evaluated the records of 90 patients who had been treated with infusions improving blood perfusion. In patients lacking complete remission, dehydration infusion therapy was added. We also undertook audiometric follow up. We calculated the outcomes after infusion therapy, dehydration therapy and after long-time hearing follow up, and we determined the prognostic relevance of several parameters of anamnesis and clinical examination to outcomes, for both therapeutic interventions and long-time hearing.

The prognosis of LFHI was significantly correlated to certain anamnestic and clinical parameters; a short duration of the disease, lack of vertigo and female gender implied a better outcome. The pretherapeutic hearing threshold was an important prognostic factor; the outcome was significantly worse in patients with distinct hearing impairment in low or high frequencies, compared with that in patients with little hearing loss. Whereas vertigo was a negative prognostic factor, the results of quantitative vestibular testing were irrelevant to the outcome. The glycerol test failed to predict the effectiveness of dehydration therapy and lacked any value in predicting prognosis.

These results allow the clinician to focus the anamnesis and diagnostic examination on prognostically relevant parameters, thus enabling a better estimation of the long-term disease course and improved counselling of patients. Furthermore, these results help to distinguish valuable from irrelevant diagnostic procedures.

Transsexualism is a condition involving a paradoxical feeling of belonging to the opposite sex. Acquiring a sex-appropriate voice is a crucial part of the patient gaining acceptance in their new gender. Speech and language therapists and otolaryngologists play an important role in influencing communication behaviour in transgender patients by altering the fundamental frequency of speech to one acceptable for the patient's sex.

Review of the literature suggests that speech and language therapy is successful at creating an acceptable fundamental frequency in transgender patients, as well as influencing other communication behaviours. Laryngeal surgery, such as cricothyroid approximation, has an important role in raising the fundamental frequency in those who do not achieve acceptable voice via non-surgical means. There is little information on patient satisfaction and quality of life measures. Research is currently underway to explore this aspect further.

Objectives: Sudden sensorineural hearing loss (SSHL) remains a challenge for the clinician. In the majority of cases, no definite cause can be found and the prognosis is variable.

Methods: The present study assessed 114 patients suffering from idiopathic SSHL, with regard to the prognostic value of demographic, epidemiologic, neurotologic and audiometric factors. In addition, the relationship between the identification of wave V in auditory brainstem responses and the final hearing outcome was investigated. All patients received 75 mg/day intravenous prednisolone, divided into three daily doses, for 10 days, with gradual tapering of the dose over the next 10 days.

Results: The results (after one year follow up) revealed the following factors to be related to a better hearing outcome: younger age; male sex; less time elapsed between the onset of hearing loss and the beginning of treatment; and an upward-sloping or cupeloid audiogram contour. The detection of wave V early in recovery and within the first month of medical treatment might also constitute a significant favourable factor in respect to hearing recovery.

Conclusions: The present study revealed that there are certain factors that affect prognosis in idiopathic SSHL. This is very important in counselling patients and may affect current clinical practice.

Objective: To evaluate expressive vocabulary growth in hearing-impaired preschool children wearing hearing aids.

Design: Prospective analysis of the outcomes of children included in the 1994 German ‘Goettinger Hoer-Sprachregister’ (GHR) series, using a repeated-measures paradigm in six- to nine-month intervals (t1–t3).

Subjects: Twenty-seven children (aged 2.0–4.4 years) with bilateral sensorineural hearing loss (with averages at frequencies of 0.5, 1, 2 and 4 kHz of >20 to >90 dB in the better ear) from the 1994 GHR series. The children were diagnosed at a mean age of 31.4 months (standard deviation (SD) 10.6 months) and fitted with a binaural hearing aid at a mean age of 32.3 months (SD 10.5 months). Nonverbal intelligence was average (five missing data entries). Standardized, age-appropriate picture naming tests (the ‘Sprachentwicklungstest für 2-jährige Kinder’, the Kaufman Assessment Battery for Children subtest vocabulary, and the ‘Aktiver Wortschatztest für drei- bis sechsjährige Kinder’) were carried out at three time points and results compared with data from children with normal hearing. The test raw scores were converted to T scores (mean = 50; SD = 10).

Results: On average, the children scored far below the normative population at t1 (mean = 28.9; SD = 11.3) and slowly improved as they got older (at t3, mean = 34.1; SD = 16.1; p = 0.010). Children with mild or moderate hearing loss improved most notably (mean difference t1–t3; p = 0.001), except for one child of deaf parents. Two of the five mildly hearing-impaired children and two of the eleven moderately hearing-impaired children caught up with their normal hearing peers with regards to expressive vocabulary. Such expressive vocabulary achievements were not seen in any children with >70 dB hearing loss or in six of the eleven children (55 per cent) with a 40–70 dB hearing loss, despite receiving adequate personal amplification.

Conclusion: Testing expressive vocabulary size is a useful clinical tool in assessing linguistic lexical outcome.

Laryngeal premalignancy is a common clinical concern. While tobacco has long been established as the principal identifiable aetiological factor, the last two decades have seen publications investigating a potential role for gastroesophageal reflux, gastrectomy and human papilloma virus. Furthermore, there have been major advances in our understanding of the molecular biology of cancer and premalignancy. Accompanying this increased understanding, significant efforts have been made to correlate the expression of molecular markers with the clinical course of premalignant laryngeal lesions.

This review summarizes current knowledge of the aetiological factors and molecular biology of laryngeal premalignancy. All aetiological factors, including molecular markers, are discussed separately and their possible role in the clinical course of these lesions is discussed.

The field of molecular biology is an important part of research into neoplastic conditions. Much of this research requires access to human tissue samples, which may need to be collected and stored in a specific way, according to the type of study for which they are intended. Anonymous clinical information about the samples enables researchers to apply results to different patient groups. Access to stored tissues is particularly important in head and neck disease research as many neoplastic conditions affecting this area have a relatively low incidence. Consequently, it may take a long time to build up enough individual cases to make a study worthwhile.

We describe here the current legal, ethical and practical issues of research tissue banking, with regard to head and neck disease.

Wilhelm Frederick von Ludwig first described in 1836 a potentially fatal, rapidly spreading soft tissue infection of the neck and floor of the mouth. The condition was later named ‘Ludwig's angina’, a term which persists in medicine to this day. A gold medallist at 19 and professor at 25, Ludwig also served as president of the Württemberg Medical Association and chief physician to the royal family. His outstanding contribution to medicine was rewarded with the title Excellence upon retiring in 1855. Ludwig died at the age of 75, ironically, days after developing an inflammation of the neck. Could it be that Ludwig died of his own condition? This article combines a biography of Wilhelm Frederick von Ludwig with an overview of his eponymous condition and its management.

Topical cocaine is used by many otorhinolaryngologists because of its good local anaesthetic and vasoconstrictive properties. A review of the available literature suggests a risk/benefit analysis would suggest that in the out-patient setting local anaesthetic agents which do not contain cocaine should be used. For rhinosurgical procedures, preparations containing cocaine and adrenaline in the appropriate concentrations and doseage are safe in the vast majority of patients without previous cardiac disease. The relative benefit of using cocaine in relation to other topical analgesics and vasoconstrictors in surgery remains unproven and alternative preparations should be used wherever there is concern over the cardiac status of the patient.

It is important to be alert to the possibility that patients presenting with a septal perforation or destructive midfacial lesions may be suffering from an addiction to cocaine. It is important to arrive at the correct diagnosis in a destructive process and even in the presence of raised antineutrophilic cytoplasmic antibodies (ANCA) a diagnosis of cocaine abuse should actively be excluded.

Syringocystadenoma papilliferum is a benign adnexal skin tumour, which, in a third of cases, arises from an organoid nevus on the head and neck. We report on a 17-year-old man with a syringocystadenoma papilliferum on his right pinna of three-years duration. The clinical and histopathological features are described. Following excision and skin grafting, the patient remains asymptomatic four years after surgery. This is the first report of a syringocystadenoma papilliferum on the pinna.