This study aimed to: understand the effect that high intensity noise associated with drilling (during otological surgery) has on hearing in the contralateral ear; determine the nature of hearing loss, if any, by establishing whether it is temporary or persistent; and examine the association between hearing loss and various drill parameters.

A prospective clinical study was carried out at a tertiary centre. Thirty patients with unilateral cholesteatoma and normal contralateral hearing were included. Patients were evaluated pre-operatively and for five days following surgery using high frequency pure tone audiometry, and low and high frequency transient evoked and distortion product otoacoustic emission testing.

The findings revealed statistically significant changes in distortion product otoacoustic emissions at high frequencies (p = 0.016), and in transient evoked otoacoustic emissions at both low and high frequencies (p = 0.035 and 0.021, respectively). There was a higher statistical association between otoacoustic emission changes and cutting burrs compared with diamond burrs.

Drilling during mastoid surgery poses a threat to hearing in the contralateral ear due to noise and vibration conducted transcranially.

The results of a number of tympanic membrane perforation closure techniques have been reported. However, relatively little has been published on the ‘drum sandwich’ technique.

Retrospective chart review of 123 patients undergoing type one tympanoplasty, performed by one surgeon using the drum sandwich technique.

Ninety-two per cent of perforations were successfully closed, and 87 per cent of patients had healed ears and were free from aural discharge 6 weeks following surgery. Post-operative hearing data were only available for 81 ears. Of these, 58 per cent had closure of the air–bone gap to within 10 dB. The mean hearing gain for the group was 10.6 dB.

The drum sandwich technique produces rapid healing of the ear with acceptable hearing outcomes. Drum closure rates are comparable with those reported for other techniques.

To examine the clinical features, age and gender distribution of patients, treatment methods, and outcomes of benign paroxysmal positional vertigo.

This paper reports a review of 357 patients treated for this condition at a single institution over a duration of 5 years. Patients with posterior canal benign paroxysmal positional vertigo were divided into two groups: one group underwent the Epley manoeuvre and the other received medication. The lateral canal canalolithiasis patients were also divided into two groups: one underwent the Lempert manoeuvre and the other received medication. Lastly, the lateral canal cupulolithiasis patients were treated with medication and non-specific physical techniques.

For patients with posterior canal benign paroxysmal positional vertigo, resolution time was significantly shorter in the Epley manoeuvre group than in the medication group. For the lateral canal canalolithiasis patients, resolution time was significantly shorter in the Lempert manoeuvre group than in the medication group. Resolution time was significantly longer in the lateral canal cupulolithiasis patients than in the other patients. The average age of patients increased with the number of recurrences, as did predominance in females. Average age and rate of sensorineural hearing loss were significantly higher in patients with intractable benign paroxysmal positional vertigo compared with those in the curable benign paroxysmal positional vertigo group.

To determine if the incidence of vestibular neuronitis displays seasonal variation.

A retrospective case review was performed to determine the monthly and quarterly incidence of vestibular neuronitis over a 36-month period. Incidence values were compiled, and the chi-square test and Rayleigh test for circular means were used to assess for uneven distribution and seasonality, respectively.

Fifty-two patients were diagnosed with vestibular neuronitis during the study period. The 2009–2010 study year showed uneven distribution and evidence of seasonality (R = 7.211, p < 0.001). However, the other two study years did not show statistical significance using either the chi-square test or Rayleigh test. In addition, when incidence values were aggregated across all three years of the study, neither the chi-square test nor Rayleigh test showed statistical significance.

The present study found minimal evidence of seasonality in the incidence of vestibular neuronitis. These findings are consistent with studies of seasonality observed for other inner-ear disorders thought to be virally mediated.

We aimed to determine: (1) whether mean platelet volume was elevated in patients with sudden sensorineural hearing loss, compared with healthy controls; and (2) whether mean platelet volume level was related to hearing loss severity.

The study included 31 patients with sudden sensorineural hearing loss and 31 age- and sex-matched, healthy controls. Peripheral venous blood samples were taken from subjects and mean platelet volume and levels of glucose, total cholesterol, high-density lipoprotein, low-density lipoprotein and triglyceride were measured.

Mean platelet volume was significantly greater in the sudden sensorineural hearing loss group compared with the control group. However, there was no significant correlation between mean platelet volume level and hearing loss severity.

Mean platelet volume, a determinant of platelet activation, is elevated in patients with sudden sensorineural hearing loss. To our knowledge, this is the first report investigating mean platelet volume levels in such patients. Our findings indirectly support the hypothesis of vascular impairment as a pathogenetic factor in sudden sensorineural hearing loss.

The present study aimed to investigate nasal mucosal changes in response to passive exposure to cigarette smoke.

The study included 20 women aged 35–51 years who were scheduled for non-rhinological surgical procedures, and who had at least 10 years' prolonged passive exposure to household cigarette smoke. During surgery, two 1-mm3 biopsies of nasal mucosa were taken from the lower border of the inferior turbinate. Specimens were processed and examined with light and transmission electron microscopy.

Examination of the nasal mucosa showed several histopathological changes. The severity of structural changes increased with duration of smoke exposure. No allergic or neoplastic changes were seen.

Passive exposure to cigarette smoke has a deleterious effect on the nasal respiratory mucosa. Prolonged passive smoke exposure may also induce other, significant changes not detected in the present study.

To report our outcomes with salvage CO2 laser surgery following recurrence of laryngeal and oropharyngeal cancer after radiotherapy.

This study entailed a prospective review of patients treated with transoral laser microsurgery for recurrent laryngeal and oropharyngeal cancer between 2002 and 2010 at the Queen Elizabeth II Health Science Centre in Canada.

Sixteen patients were identified, with a mean follow up of 30.6 months. Five patients died of recurrence. Complications were common in patients with oropharyngeal cancer. The overall survival and disease-free survival rates at an average of 29.8 months follow up were 50 per cent and 68.8 per cent respectively.

Salvage surgery using transoral laser microsurgery should be considered in the management of patients with recurrent laryngeal and oropharyngeal cancer. This technique offers acceptable salvage rates with less comorbidity than other treatments.

To investigate perceptual, acoustic and aerodynamic voice parameters in obese individuals.

Twenty obese and 20 normal-weight volunteers underwent voice evaluation by laryngoscopy, acoustic analysis, aerodynamic measurement and perceptual analysis (using the grade-roughness-breathiness-asthenia-strain (‘GRBAS') scale and the Voice Handicap Index 10 scale). Data from both subject groups were compared.

No difference was found in acoustic analysis parameters between the two groups (p > 0.05). Maximum phonation time in the obese group (mean ± standard deviation, 19.6 ± 4.9 seconds) was significantly shorter than in controls (26.4 ± 4.1 seconds) (p < 0.001), although the s/z ratio was very similar between the two groups. In the obese and control groups, the mean ± standard deviation grade-roughness-breathiness-asthenia-strain scores were 1 ± 1.3 and 0.2 ± 0.6 (p = 0.002) and the mean ± standard deviation Voice Handicap Index 10 scores were 0.5 ± 1.2 and 1.2 ± 1.7 (p = 0.27), respectively.

Obese individuals had poorer vocal quality as judged by the grade-roughness-breathiness-asthenia-strain scale, and reduced maximum phonation time. However, there was no change in voice quality as assessed by acoustic analysis and Vocal Handicap Index 10 score, compared with controls.

Follow-up surveillance of head and neck cancer patients varies throughout the UK. The heterogeneity of these patients limits the applicability of a standardised protocol. Improvements in our understanding of the natural history of the disease may assist in the tailoring of resources to patients.

Prospective data collected at the Cumberland Infirmary over a 13-year period were analysed, primarily focusing upon recurrence rates and time to recurrence.

In keeping with other studies, recurrence of head and neck squamous cell carcinoma was found to be maximal within the first three years of treatment, regardless of subsite.

Hospital-based surveillance may be safely discontinued after three years for some patients. Laryngeal carcinoma may require further surveillance due to possible delayed recurrence of a second primary formation. Emphasis must be placed on patient education, accessibility to head and neck services, and the existence of a robust system to facilitate urgent referrals.

To investigate the relationship between development of laryngeal cancer and the presence of polymorphisms of the MnSOD Val16Ala, CAT-262 C < T and GPx1 Pro198Leu genes in a smoking population.

Single nucleotide polymorphisms were determined in DNA from the peripheral blood erythrocytes of 48 heavy smokers (25 patients with laryngeal cancer and 23 cancer-free controls), using polymerase chain reaction.

There were no significant differences in age, smoking duration or smoking intensity, comparing the two groups. The homozygous AA genotype of MnSOD Val16Ala was significantly more prevalent in the cancer group than the control group (92 vs 13 per cent, respectively), while the heterozygous AV genotype of MnSOD Val16Ala was more prevalent in the control group than the cancer group (87 vs 8 per cent, respectively) (p < 0.001). There were no significant differences between the cancer and control groups regarding GPx1 Pro198Leu or CAT-262 C < T polymorphisms.

Polymorphism of the MnSOD Val16Ala gene may contribute to susceptibility to laryngeal cancer among smokers.

Diagnostic ability is essential in laryngology. The UK Higher Surgical Training syllabus includes competencies specific to laryngology. This study aimed to identify the factors in training that lead to a consultant level of laryngology-related diagnostic ability.

An online test of training experience was constructed using laryngoscopy videos obtained from a specialist UK voice clinic. Participation was aimed at both trainees and trainers via invitation through national ENT forums.

There were 51 complete responses. Trainees with six months of laryngology experience scored significantly higher than those without this experience (p < 0.001). There was no improvement in score demonstrated for those with head and neck specialty experience without laryngology experience. Trainees who had completed 12 months of laryngology, or 6 months of laryngology coupled with 12 months of head and neck training, scored similarly to their consultant trainers.

It is recommended that all trainees have at least six months of experience in a specialist voice or laryngology placement prior to gaining the Certificate of Completion of Training.

Patients with enlarged lymph nodes present to a number of different specialties and diagnosis is often made following a biopsy.

This study aimed to establish department waiting times for cervical lymph node biopsy, and compare these to the cancer services guidelines.

A retrospective audit was carried out to record patient waiting times (defined as the number of days from referral to biopsy) between May and December 2010. A proforma for referral was introduced. In addition, appointments for biopsies were arranged by a co-ordinator. A prospective re-audit was carried out from March to September 2011.

The first audit showed that national guidelines were not met; there was a median waiting time of 74 days (interquartile range, 47–113). Re-audit demonstrated a significant reduction in waiting times using the proforma; the median waiting time had decreased to 18 days (interquartile range, 9–22).

A proforma for lymph node biopsy and a designated co-ordinator streamlined the service, significantly reducing waiting times. Together, these can aid referral for meeting guidelines and improve patient care.

The objective of the current study was to compare the outcomes of rigid endoscopic procedures with those of pre-operative flexible nasoendoscopy.

A total of 253 patients who had undergone rigid endoscopic examination under anaesthesia between 6 January 2010 and 31 August 2011 were identified. Their clinical, surgical and histological records were evaluated.

A total of 213 patients had a flexible nasoendoscopic procedure performed and recorded pre-operatively, and 82 in this cohort had a specific lesion or area of concern identified. There were 21 confirmed malignant biopsy results, the majority of which were squamous cell carcinoma. No patient with a negative pre-operative endoscopy had a malignant lesion discovered on endoscopic biopsy. The sensitivity and specificity of pre-operative nasoendoscopy were 100 per cent and 66.3 per cent, respectively.

Diagnostic rigid endoscopic examination of the upper aerodigestive tract remains an important tool for excluding malignancy in high-risk patients, but is an unnecessary procedure in those low-risk patients with normal pre-operative findings.

We report a rare case of temporal bone metastasis from a lung primary, presenting only as post-aural tenderness.

A 57-year-old man presented to our out-patient department with left post-aural pain of four months' duration. Clinical examination revealed tenderness in the left post-aural region; the ear, nose and throat examination was otherwise unremarkable. Computed tomography and contrast-enhanced magnetic resonance imaging showed erosion of the left petrous temporal bone. Incisional biopsy was carried out. Histopathological and immunohistochemical analysis showed infiltrative metastatic adenocarcinoma of the lung. Further imaging with positron emission tomography confirmed increased uptake from the right lower lobe of the lung, suggesting the site of the primary lesion. The patient was treated with chemo-radiotherapy.

Post-aural pain is a non-specific symptom, and, with normal clinical and audiometric test results, rare lesions such as the one presented could be easily missed. A thorough clinical examination must be performed to identify genuine signs, and appropriate imaging undertaken to exclude rare causes, such as this metastatic lesion of the temporal bone.

Rhinosporidiosis primarily affects the mucous membranes of the nose and nasopharynx. The disseminated form of this chronic fungal disease is extremely rare.

The authors present a case of disseminated rhinosporidiosis in an immunocompetent patient with involvement of the skin, subcutaneous tissue, muscle, bone, penis and urethra, and with a long-standing primary lesion in the nose.

A late or atypical presentation of rhinosporidiosis may cause diagnostic dilemma. Fine needle aspiration cytology of the tumoural lesions may establish the diagnosis. Histopathology is confirmatory. The subcutaneous masses may be solid or cystic. Ulceroproliferative lesions need to be differentiated from malignancies.

This is the first reported case of truly disseminated rhinosporidiosis with simultaneous involvement of multiple anatomically unrelated sites in a single patient. This is also the first reported case of cystic rhinosporidiosis. The possibility and sequelae of spontaneous regression of rhinosporidiosis are also discussed.

To report previously unreported complications of bilateral sphenopalatine artery ligation.

We present the case of a 45-year-old man who underwent bilateral sphenopalatine artery ligation to control intractable posterior epistaxis. After four months, he re-presented with nasal obstruction and crusting.

Examination under general anaesthesia showed posterior septal perforation and bilateral necrosis of the lower parts of the middle turbinates. The necrotic parts were excised. The patient had no more complaints.

Following sphenopalatine artery occlusion, ischaemic necrosis is a potential risk in anatomical areas that receive their only arterial supply from this artery. The staging of bilateral sphenopalatine artery occlusion needs to be studied.

A simple subcutaneous lesion such as an epidermoid cyst can present a challenge when located in the nasal tip, as regards aesthetic surgical management. Even when performed parallel to relaxed skin tension lines, a direct transcutaneous incision (commonly used for epidermoid cyst removal) distorts the nasal tip subunit, resulting in a conspicuous, disfiguring scar. This should be avoided, especially in children.

A 13-year-old girl was referred by her dermatologist for diagnosis and treatment of a slowly progressive dermoid cyst located on the tip of her nose. The cyst was removed using a subcutaneous open rhinoplasty approach, leaving the aesthetic nasal tip subunit intact.

For aesthetic reasons, open rhinoplasty should be considered as a treatment option in patients with subcutaneous lesions in the nasal tip.

Major haemorrhage is a catastrophic complication occurring in 3–4 per cent of head and neck cancer patients. Massive haemorrhage also causes 50 per cent of preventable deaths in combat situations. There has been a surge of interest in the development of effective haemostatic products in the military, with chitosan being one such product.

A 48-year-old lady presented with a life-threatening head and neck bleed. She was known to have a malignant peripheral nerve sheath sarcoma originating from the left parapharyngeal space. Bleeding was successfully controlled with the application of Celox™ granules, a chitosan-based product currently used in the military.

This paper describes the first known use of a military haemostatic agent to control a malignant head and neck bleed. Celox granules can be poured directly onto a wound to enhance haemorrhage control. The suggested mechanism of action and reports of current uses of haemostatic agents are described.

We present a case of large, symptomatic lingual thyroid which was successfully and safely removed via a transoral approach, using the da Vinci robotic system, in an academic medical centre in Singapore.

A 17-year-old female adolescent presented with a large lingual thyroid causing upper airway obstruction. She underwent robotic, minimally invasive, transoral resection using the da Vinci system. Post-operative recovery was uneventful; she was able to commence oral feeding almost immediately, and was discharged from hospital on the fourth post-operative day.

It is surgically feasible and safe to undertake transoral robotic resection of a large lingual thyroid. This approach may allow faster recovery and shorter hospitalisation for patients. Surgical safety requires a full understanding of the intralingual neurovascular anatomy.