Temporalis fascia has become the most widely used graft for tympanoplasty, as it is strong, durable, and easy to procure and handle. However, the type of temporalis fascia graft to use (i.e. dry or wet) remains controversial. The present review aimed to evaluate the success rates of dry and wet temporalis fascia grafts in type I underlay tympanoplasty.

A literature search was performed, using PubMed up to August 2016, to identify all studies of dry and wet temporalis fascia grafts in type I underlay tympanoplasty. The initial search using the key words ‘temporalis fascia’ and ‘tympanoplasty’ identified 130 articles; these were screened by reviewing the titles or abstracts based on the inclusion and exclusion criteria. Ultimately, this review included seven articles.

A dry or wet temporalis fascia graft did not affect the outcome of type I underlay tympanoplasty. However, using wet temporalis fascia could shorten the duration of surgery in type I underlay tympanoplasty. Concerns that the fibroblast count of temporalis fascia may beneficially affect success rate have not been substantiated in clinical reports thus far.

The pyriform aperture comprises the central area of facial bone structure. It is formed by the free corners of the nasal bone and the frontal processes of the maxillae, which articulate with each other at the nasomaxillary suture lines. Congenital nasal pyriform aperture stenosis might be linked to various craniofacial problems. This review presents all aspects of pyriform aperture stenosis and enlargement.

A literature search was conducted. Pyriform aperture definition, nasal development, congenital nasal pyriform aperture stenosis and pyriform aperture enlargement were reviewed.

One of the most common abnormalities is holoprosencephaly, which is a midline developmental deficiency that may also be present in combination with facial clefting. The aetiology of nasal pyriform aperture stenosis remains unclear. When diagnosed, the choice of treatment is between non-surgical and operative methods, depending on the seriousness of the problem. Provided the sufferer can maintain a secure air passage with the help of specialised medical procedures and respiratory tract adjuvants, operative therapy may be delayed.

The operative outcomes are extremely good, and the prognosis relies mainly on coexisting neural and endocrine problems. This paper evaluates the nasal pyriform aperture in detail.

The incidence of thyroid cancer is increasing. There is conflicting evidence as to why. However, studies suggest that it is not an apparent increase resulting from enhanced diagnostic practices, but a true increase with more affected patients. This study aimed to assess racial variation in thyroid cancer.

A narrative systematic review of the literature was conducted.

Eight retrospective cohort studies were identified, comprising 611 777 adult patients. Variations exist between racial groups, which are also dependent on gender; white patients have a slightly higher male population when compared to their counterparts. Black and white patients have a higher proportion of follicular cancer. Hispanics were younger at the age of diagnosis. Outcomes are greatly affected by socioeconomic status.

This study identified many gaps in the way that these types of data are presented. A more concise manner of reporting, with individual-level risk factors, is recommended.

This study aimed to evaluate migration of the receiver–stimulator after cochlear implantation using the subperiosteal pocket technique.

A prospective clinical study was performed of 32 paediatric patients (aged between 12 months and 8 years; mean ± standard deviation, 28 ± 19 months) who underwent cochlear implantation in tertiary referral centres. The degree of migration was evaluated using measurements between the receiver–stimulator and selected reference points: the lateral canthus, tragus and mastoid tip. All distances were measured during and six months after surgery.

No receiver–stimulator migration was observed when using the subperiosteal pocket technique.

Concerns about implant migration in the subperiosteal pocket technique are unwarranted: this is a safe technique to use for cochlear implantation.

This study aimed to compare the reporting of high-resolution computed tomography of temporal bones for otosclerosis by general radiologists and a neuroradiologist within a local National Health Service Trust.

A retrospective case review of 36 high-resolution temporal bone computed tomography images obtained between 2008 and 2015 from 40 otosclerosis patients (surgically confirmed) was performed in a district general hospital setting. The main outcome measures were correct identification of otosclerosis by high-resolution computed tomography and adherence to the petrous temporal bone imaging protocol.

Correct diagnosis rates were significantly different when made by general radiologists vs a neuroradiologist (p < 0.0001; two-tailed Fisher's exact test). None of the high-resolution computed tomography scans adhered to the temporal bone imaging protocol.

The use of high-resolution computed tomography for suspected otosclerosis is helpful for diagnosis, disease staging, obtaining informed consent, surgical planning and prognosis. This study suggests that radiological detection of otosclerotic changes by high-resolution computed tomography of the temporal bone is significantly better when performed by a dedicated neuroradiologist than by a general radiologist. Use of a standardised temporal bone computed tomography protocol is recommended to provide consistently high-quality images for maximising disease detection.

To determine whether thiocolchicoside, a commonly used myorelaxant, may impair the acoustic reflex.

Forty-two patients scheduled to receive thiocolchicoside treatment for different reasons were enrolled in the study. Acoustic reflex thresholds at 500, 1000, 2000 and 4000 Hz were determined and analysed statistically pre-treatment and on the 5th day of treatment.

Increases were observed in the mean acoustic reflex thresholds on the 5th day of treatment compared to pre-treatment, at all frequencies, except right contralateral thresholds at 500 and 2000 Hz. These increases were statistically significant for right ipsilateral thresholds at 2000 and 4000 Hz, left ipsilateral thresholds at 500, 1000, 2000 and 4000 Hz, and left contralateral thresholds at 2000 and 4000 Hz (p ≤ 0.05), but not at other frequencies (p > 0.05).

Muscle relaxant drugs, especially those affecting the central nervous system, may weaken the stapedial muscle so that the ability of noise to cause acoustic trauma may become evident. For this reason, physicians should advise their patients to avoid loud noises when muscle relaxant therapy is prescribed.

Psychotherapeutic interventions have been adopted effectively in the management of tinnitus for a long time. This study compared mindfulness meditation and relaxation therapy for management of tinnitus.

In this randomised controlled trial, patients were recruited for five sessions of mindfulness meditation or five sessions of relaxation therapy. Patients’ responses were evaluated using the Tinnitus Reaction Questionnaire as a primary outcome measure, and the Hospital Anxiety and Depression Scale, visual analogue scale and a health status indicator as secondary outcome measures.

A total of 86 patients were recruited. Thirty-four patients completed mindfulness meditation and 27 patients completed relaxation therapy. Statistically significant improvement was seen in all outcome measures except the health status indicator in both treatment groups. The change in treatment scores was greater in the mindfulness meditation group than in the relaxation therapy group.

This study suggests that although both mindfulness meditation and relaxation therapy are effective in the management of tinnitus, mindfulness meditation is superior to relaxation therapy.

Benign paroxysmal positional vertigo and migraine-associated dizziness are common. The prevalence of benign paroxysmal positional vertigo seems to be higher in patients with migraine-associated dizziness than in those without migraine.

A database of 508 patients seen at the primary author's balance clinic was analysed to determine the prevalence of migraine, as defined by International Headache Society criteria, in patients with benign paroxysmal positional vertigo.

The percentage of patients with dizziness or vertigo who met criteria for migraine was 33.7 per cent, with a prevalence of benign paroxysmal positional vertigo of 42.3 per cent. When excluding patients with migrainous vertigo, patients with migraine frequently had benign paroxysmal positional vertigo (66.7 per cent vs 55.8 per cent), although this finding was not statistically significant.

The results for the entire sample suggest that, after excluding patients with migrainous vertigo, patients with migraine seem more likely to have benign paroxysmal positional vertigo; however, this association was not significant, probably because of the small sample size.

The Chronic Otitis Media Questionnaire 12 was developed initially in the UK to assess patient-reported health-related quality of life associated with chronic otitis media. This study aimed to determine whether this tool is applicable to the Russian population, which has a materially different healthcare system.

A total of 108 patients with different forms of chronic otitis media completed the Russian Chronic Otitis Media Questionnaire 12.

The average Russian Chronic Otitis Media Questionnaire 12 score was 19.4 (standard deviation = 8.3). The internal consistency of the Russian Chronic Otitis Media Questionnaire 12 was high, with a Cronbach's alpha value of 0.860.

The Russian version of the Chronic Otitis Media Questionnaire 12 was found to be a reliable tool for the assessment of health-related quality of life in patients with chronic otitis media. This sets the scene for international collaboration, using this tool to assess the effectiveness of surgical treatments even amongst countries with different healthcare systems.

To investigate the feasibility of a national audit of epistaxis management led and delivered by a multi-region trainee collaborative using a web-based interface to capture patient data.

Six trainee collaboratives across England nominated one site each and worked together to carry out this pilot. An encrypted data capture tool was adapted and installed within the infrastructure of a university secure server. Site-lead feedback was assessed through questionnaires.

Sixty-three patients with epistaxis were admitted over a two-week period. Site leads reported an average of 5 minutes to complete questionnaires and described the tool as easy to use. Data quality was high, with little missing data. Site-lead feedback showed high satisfaction ratings for the project (mean, 4.83 out of 5).

This pilot showed that trainee collaboratives can work together to deliver an audit using an encrypted data capture tool cost-effectively, whilst maintaining the highest levels of data quality.

Chronic rhinosinusitis is a common nasal disorder in children that is prone to recurrence. This study investigated the prevention of chronic rhinosinusitis recurrence with bacteria lysate in children.

Bacteria lysate was administered 10 days per month for 3 months to children with chronic rhinosinusitis, who had just entered a remission phase. Visual analogue score, nasal symptoms scores, rhinitis attack frequency and antibiotic use were assessed at three months and one year.

At one year of follow up, the visual analogue score, nasal discharge and obstruction scores, number of days with rhinitis attacks per month and number of days with antibiotic use per month were significantly decreased in the prevention group versus the control group (p < 0.05).

Bacterial lysate used in the remission period of rhinosinusitis in children was shown to provide long-term prophylaxis. Bacterial lysate can effectively reduce the frequency of rhinosinusitis attacks and ameliorate attack symptoms.

Conchal cartilage is frequently used in rhinoplasty, but donor site morbidity data are seldom reported. This study aimed to investigate the complications of conchal cartilage harvesting in rhinoplasty.

A retrospective chart review of 372 patients who underwent conchal cartilage harvesting for rhinoplasty was conducted. Data regarding patient demographics, types of nasal deformities, graft usage and complications were analysed.

A total of 372 patients who underwent conchal cartilage harvesting for rhinoplasty were enrolled. The harvested conchal cartilage tissues were used in a variety of applications: tip graft, dorsal graft, septal reinforcement and correction of nostril asymmetry. Nine cases (2.4 per cent) with donor site morbidities were identified, including four cases (1.1 per cent) with keloids and five cases (1.3 per cent) with haematomas.

Conchal cartilage harvesting is a safe and useful technique for rhinoplasty, with a low complication rate. However, patients should be informed about the possibility of donor site morbidities such as keloids and haematomas.

Despite advances in endoscopic sinus surgery, frontal sinus obliteration is still indicated in some cases. Current options for obliteration include autologous and synthetic materials. The use of ß-tricalcium phosphate as a resorbable bone graft substitute is a good alternative for frontal sinus obliteration. This study aimed to report our experience with this material.

A retrospective chart review of patients who underwent frontal sinus obliteration at our clinic between 2008 and 2013 was performed. Demographic data, indications, previous surgery, and immediate and late complications were examined. Information on persisting symptoms and patient outcomes was collected using a telephone questionnaire in February 2016.

None of the patients underwent further surgery for frontal sinus disease. All of them reported a good cosmetic result and symptom improvement.

ß-tricalcium phosphate is a good, safe and cost-effective material for frontal sinus obliteration.

The choices made by patients offered treatment for early laryngeal cancer with radiotherapy or transoral laser resection were reviewed.

A prospective review was conducted of all patients diagnosed and treated for early laryngeal carcinoma from December 2002 to September 2009 at the Leeds Teaching Hospitals NHS Trust. A total of 209 patients with tumour stage T1 or T2 laryngeal cancer were treated; each new patient suitable for radiotherapy or transoral laser resection was seen jointly by the clinical (radiation) oncologist and head and neck surgeon, and offered the choice of treatment.

Of the patients, 47.4 per cent were given a choice between radiotherapy and transoral laser resection; 51.2 per cent were advised to have radiotherapy, and there were no records for the remaining 1.4 per cent. From those given the choice, 59.6 per cent chose transoral laser resection (p < 0.02 (t-test)) and 35.4 per cent chose radiotherapy.

When given the choice, a statistically significant majority of patients choose transoral laser resection rather than radiotherapy.

NHS England has commissioned intensity-modulated radiotherapy for head and neck cancers from Newcastle hospitals for patients in North Cumbria. This study assessed whether travel distances affected the decision to travel to Newcastle (to receive intensity-modulated radiotherapy) or Carlisle (to receive conformal radiotherapy).

All patients for whom the multidisciplinary team recommended intensity-modulated radiotherapy between December 2013 and January 2016 were included. Index of multiple deprivation scores and travel distances were calculated. Patients were also asked why they chose their treating centre.

Sixty-nine patients were included in this study. There were no significant differences in travel distance (p = 0.53) or index of multiple deprivation scores (p = 0.47) between patients opting for treatment in Carlisle or Newcastle. However, 29 of the 33 patients gave travel distance as their main reason for not travelling for treatment.

Quantitatively, travel distance and deprivation does not impact on whether patients accept intensity-modulated radiotherapy. However, patients say distance is a major barrier for access. Future research should explore how to reduce this.

To identify Helicobacter pylori infection in tonsillar tissue samples from patients undergoing tonsillectomy for chronic tonsillitis versus tonsillar hypertrophy, and to assess the possible relationships between H pylori and patients’ sociodemographic data and laryngopharyngeal reflux.

In this prospective study, 97 patients who underwent tonsillectomy were divided into the following 2 groups: patients with chronic tonsillitis (n = 62) and patients with tonsillar hypertrophy (control group; n = 35). H pylori infection in the tonsillar biopsy samples was identified using histochemical and rapid urease tests.

The incidence of H pylori infection was significantly higher in the chronic tonsillitis group (56.5 per cent) compared to the control group (31.4 per cent). Similar findings were obtained for both subgroups of adults (68.6 vs 42.3 per cent) and children (40.7 vs 0.0 per cent). Significant relationships between a positive H pylori finding and laryngopharyngeal reflux related signs of vocal fold oedema, diffuse laryngeal oedema and hypertrophy of the posterior commissure were revealed.

H pylori infection may be related to chronic tonsillitis and laryngopharyngeal reflux.

This paper reports three cases of severe post-stapedectomy granuloma, emphasising the variable presentation of this devastating complication and the challenges of its management.

A retrospective review was conducted of three cases of post-stapedectomy granuloma requiring surgical debulking between 2010 and 2015. Clinical symptoms, serial imaging, histopathology and post-operative outcomes were considered.

Intra-operatively, extensive granulation tissue with erosion of the otic capsule was found. There was spread along the VIIth and VIIIth cranial nerves to the cochlear nucleus in one patient. Post-operative clinical improvement was demonstrable, corroborated by diminution of contrast enhancement on serial magnetic resonance imaging. Facial nerve function recovered, tinnitus amelioration was variable and some otalgia persisted. Post-operative complications included grade IV facial weakness and late Pseudomonas aeruginosa meningitis, which all resolved.

To the authors’ knowledge, this paper reports the only case of post-stapedectomy granuloma tracking to the brainstem. Otalgia was present in all our cases, and may be deemed a red flag symptom of progressive bony destruction and otic capsule involvement. Although granuloma remains rare, it should be considered in any patient with worsening otological symptoms following stapes surgery.