Management of the pharyngeal pouch has evolved enormously since the first description by Ludlow in 1764 and the first case series by Zenker and Von Ziemssen in 1877. With the introduction of antibiotics, and the advancement of surgical technique with the advent of endoscopic surgery and lasers, current management is vastly different to that in the nineteenth century.

This paper traces the history of pharyngeal pouch management, and discusses the various treatment options and opinions recorded during the nineteenth and twentieth centuries, comparing these with techniques popular today.

Pharyngeal pouch surgery has been associated with significant morbidity, both because of the elderly age of patients typically affected by the condition and because of the surgery itself and potential post-operative complications encountered. The historical development of pharyngeal pouch management and the understanding of pharyngeal pouch pathophysiology are discussed.

The frequency with which a scientific article is cited by other studies is one way to measure its academic influence.

A comprehensive search was performed to identify journal articles in the otorhinolaryngology subject category of the 2013 Journal Citation Report Science Edition over the last 30 years (1985–2014). The 100 most cited articles were reviewed and basic information including the publication year, country of origin, source journal, article type and research field was collected.

The 100 most cited articles were published in 15 of the 44 otorhinolaryngology journals. The number of citations per article ranged between 208 and 1559. The leading research field was otology and neurotology (n = 50), followed by rhinology (n = 23) and head and neck surgery (n = 11). Most papers originated in the USA (n = 64).

The possibility of an article being cited is influenced by the publication language, country of origin and source journal.

To investigate whether cochlear involvement is an extraintestinal manifestation in patients with ulcerative colitis.

Forty-four ulcerative colitis patients and 44 age-matched healthy subjects were included in the study. Pure tone and speech audiometry, and distortion product otoacoustic emission tests were performed on all participants. The audiometric test results were compared between groups and their relationship with disease activity was investigated.

Pure tone threshold averages were significantly higher in ulcerative colitis patients compared to controls (p < 0.05). Speech discrimination scores were significantly lower in ulcerative colitis patients compared to controls (p < 0.05). Distortion product otoacoustic emission amplitude values were significantly lower for all of the tested frequencies (except for 6000 Hz in the right ear) in ulcerative colitis patients compared to controls (p < 0.05). No relationship was detected between audiometric test results and disease activity (p > 0.05).

Even though hearing thresholds may be within normal limits, decreased distortion product otoacoustic emission amplitude values indicate a cochlear involvement in ulcerative colitis patients.

To establish the prevalence of stapes obliquity as observed in otosclerosis patients during stapes surgery by a simple method of intra-operative measurement.

Prospective observational study.

Intra-operative measurements showed that the mean distance (± standard deviation) between the horizontal segment of the facial nerve and stapes crura in 10 cases of otosclerosis was 0.74 mm (± 0.21 mm), whereas in 10 cases of non-otosclerosis the same distance was 0.20 mm (± 0.00). There was no gap (0 mm) between the stapes crura and inferior border of the oval window niche in otosclerotic ears, whereas in non-otosclerotic ears the same distance was 0.13 mm (± 0.05 mm). The differences were statistically significant (p < 0.0001).

Obliquity and downward displacement of the stapes occurs in otosclerosis. It has diagnostic value as a new clinical sign in otosclerosis. The findings correlate with late complications and failures in stapes surgery. Methods to avoid these have been suggested.

This study aimed to evaluate the results of the video head impulse test and of the caloric and rotatory chair tests in patients with dizziness. Agreement between test results was assessed and the best protocol for detecting peripheral vestibulopathy was identified.

Participants comprised 116 patients, 75 with a peripheral vestibulopathy and 41 with non-peripheral vestibulopathy. The main outcome measures were classified as normal or abnormal according to our laboratory data.

Agreement between tests was low. Vestibulopathy testing that required all three results to be abnormal had a sensitivity of 0.547, a specificity of 0.878, and positive and negative predictive values of 0.891 and 0.514, respectively. Vestibulopathy testing that required just one result to be abnormal had a sensitivity of 0.933, a specificity of 0.292, and positive and negative predictive values of 0.701 and 0.705, respectively.

In peripheral vestibulopathy, there was weak concordance in the assessment of horizontal semicircular canal function among the different tests. However, the video head impulse test had sufficient statistical power to be recommended as the first-line test.

Cochlear implantation is mostly performed under general anaesthesia. This study aimed to evaluate cochlear implantation performed under local anaesthesia and sedation.

Twenty patients had a cochlear implant fitted under combined local anaesthesia (local anaesthesia group) and 41 patients had one fitted under general anaesthesia (general anaesthesia group) for bilateral profound hearing loss, from 2011 to 2014. Surgical duration, period of post-operative hospitalisation and early post-operative symptoms were compared. In the local anaesthesia group, operative symptoms reported during the surgery and by questionnaire were analysed.

Mean surgical duration was significantly shorter in the local anaesthesia group: 87 versus 122 minutes (p < 0.001). No significant difference was observed between the local anaesthesia and general anaesthesia groups regarding mean post-operative hospitalisation and early post-operative symptoms. Under local anaesthesia, patients had no particular symptoms in 60 per cent of cases. The remaining patients in this group experienced vertigo (10 per cent), pain (20 per cent) and pain-related movement (10 per cent) during the intervention. These symptoms can be controlled with symptomatic treatment.

Combined local anaesthesia for cochlear implantation is a good alternative to general anaesthesia for co-operating patients.

This paper objectively evaluates current information available to the general public related to glue ear on the World Wide Web.

The term ‘glue ear’ was typed into the 3 most frequently used internet search engines – Google, Bing and Yahoo – and the first 20 links were analysed. The first 400 words of each page were used to calculate the Flesch–Kincaid readability score. Each website was subsequently graded using the Discern instrument, which gauges quality and content of literature.

The websites Webmd.boots.com, Bupa.co.uk and Patient.co.uk received the highest overall scores. These reflected top scores in either readability or Discern instrument assessment, but not both. Readability and Discern scores increased with the presence of a marketing or advertising incentive. The Patient.co.uk website had the highest Discern score and third highest readability score.

There is huge variation in the quality of information available to patients on the internet. Some websites may be accessible to a wide range of reading ages but have poor quality content, and vice versa. Clinicians should be aware of indicators of quality, and use validated instruments to assess and recommend literature.

This study aimed to determine whether there was any relationship between tinnitus and mean platelet volume.

This retrospective study was conducted between January 2013 and January 2014 in Ankara Atatürk Hospital and Ondokuz Mayıs University Hospital, Turkey, on a study group of 86 patients with tinnitus and a control group of 84 healthy subjects. Mean platelet volume was recorded and comparisons were made between the two groups.

Mean (± standard deviation) platelet volume was 7.67 ± 0.83 μm3 in the study group and 7.28 ± 0.56 μm3 in the control group. There was a statistically significant difference in mean platelet volume between the tinnitus patients and the healthy subjects (p < 0.05).

The clinical findings indicated that tinnitus patients had a higher mean platelet volume than the healthy control subjects; however, the pathophysiological mechanism remains unclear.

The likelihood of a patient attending regular follow up can affect decision making when planning and performing tympanomastoid surgery. This study investigated whether demographic factors were associated with loss to follow up.

A database of patients who had been investigated and treated for chronic otitis media was searched. Patients lost to follow up and a matching sample of patients who were formally discharged were identified. The demographic factors of age, sex and postcode were compared between the two groups. The information collected was also used to provide measures of deprivation.

Fifty patients in each group were identified. Patients lost to follow up were significantly younger than patients formally discharged (p < 0.02), and were more likely to live in an area of education and training deprivation (p < 0.05).

Younger patient age, and living in an area of education and training deprivation, are associated with a higher incidence of loss to follow up.

Very little up-to-date information is available on the microbiology of complicated acute bacterial rhinosinusitis. Reliable microbiology testing is necessary to inform current empirical antimicrobial treatments. This study was conducted in response to recent US guidelines on antimicrobial treatments for acute bacterial rhinosinusitis. It aimed to describe the pathological micro-organisms involved in complicated acute bacterial rhinosinusitis in the UK and their antimicrobial susceptibility.

This study collected retrospective data on cases of complicated acute bacterial rhinosinusitis with sinogenic orbital and/or intracranial infections from 2007 to 2012. Bacteria identified in paranasal sinus pus were compared with those identified in orbital and/or intracranial infections.

Streptococcus anginosus group bacteria were isolated from 61.3 per cent of paranasal sinus pus samples, 83.3 per cent of orbital infections and 77.8 per cent of intracranial infections. All S anginosus isolates were sensitive to penicillin; no penicillin-resistant organisms were isolated.

S anginosus was the predominant organism isolated from complicated acute bacterial rhinosinusitis samples at our UK centre. S anginosus is sensitive to penicillin, suggesting that penicillin can be used as an appropriate first-line empirical antibiotic for uncomplicated acute bacterial rhinosinusitis.

Giant basal cell carcinoma, in which the tumour measures 5 cm or greater in diameter, is a very rare skin malignancy that accounts for less than 1 per cent of all basal cell tumours. Very few studies have reported on the incidence, resection and reconstruction of this lesion worldwide.

In total, 17 patients with giant basal cell carcinoma of the head and neck region underwent surgical excision and reconstruction at our hospital. Medical charts were retrospectively reviewed and analysed.

The lesion was usually in the forehead, eyelid, lips or nasal-cheek region. The greatest diameter ranged from 5 to 11 cm, with 5–6 cm being the most common size at the time of presentation. All patients had their tumour resected and reconstructed in a single-stage procedure, mostly with a local advancement flap, and with no post-operative flap failure.

Giant basal cell carcinoma of the head and neck can be successfully treated with a local flap in a single-stage approach.

Given the urgent nature of ENT emergencies, appropriate knowledge is required amongst front-line staff. Junior doctors account for almost one quarter of emergency department doctors. It has been shown that undergraduate coverage of ENT is variable. This study therefore aimed to determine whether emergency department junior doctors were confident in dealing with ENT emergencies, with special focus on the airway.

An online survey was circulated to junior doctors working in emergency medicine, at the discretion of their training co-ordinators.

A total of 104 responses were received. Junior doctors were not confident in managing patients who have undergone tracheostomy or laryngectomy. Management of stridor varied, with 51 per cent giving oxygen and only 77 per cent referring such patients as an emergency to ENT. Most training on the management of airway emergencies was not provided through hospital induction.

Training should be provided to junior doctors starting work in the emergency department. We suggest mandatory multidisciplinary induction training for such staff.

Voice restoration after laryngopharyngectomy can be achieved with an autologous ileocolic flap. We have observed that the length of the flap influences vocal outcome. This investigation aimed to evaluate the association between ileocolic flap length and vocal quality after laryngopharyngectomy.

The charts of patients who underwent voice rehabilitation with an ileocolic flap after laryngopharyngectomy between 1 January 2011 and 30 December 2012 were abstracted. The length of ileum segment in the ileocolic flap was stratified, and voice outcome was evaluated three months post-operatively, while adjusting for confounding variables.

There was a significant association between flap length and loudness, maximum phonation time and sound pressure level (p < 0.05). All three parameters were best in the 10 cm length group.

Voice rehabilitation after laryngopharyngectomy is possible with an ileocolic flap. The optimal ileocolic flap contains a 10 cm ileum segment. Complications are frequent but amenable to revision surgery.

This study aimed to: assess the mucosal alterations of the larynx and hypopharynx typical for mucopolysaccharidoses, in a standardised manner; compare the severity in different subtypes of mucopolysaccharidoses; and monitor the effect of an enzyme replacement therapy.

A classification for mucosal alterations of the larynx and hypopharynx was developed and utilised in 55 patients with mucopolysaccharidoses. Fifteen patients who started treatment with enzyme replacement therapy were followed longitudinally.

The most severe alterations were seen in the posterior region of the larynx and the arytenoids, and in the region of the false vocal folds. The alterations were most severe in patients with mucopolysaccharidosis II. No clear trend was observed in the patients who received enzyme replacement therapy.

Quantification of mucosal alterations of the hypopharynx and larynx in mucopolysaccharidoses patients can provide information about the disease's natural process and about the efficacy of enzyme replacement therapy.

An increasing number of inexperienced doctors are rotating through otolaryngology departments and providing care to ENT patients. Numerous acute ENT conditions require basic surgical or technical intervention; hence, effective and efficient simulation induction training has become paramount in providing a safe yet valuable educational environment for the junior clinician. Whilst simulation has developed over the years for numerous ENT skills, to date there has not been a realistic and easily reproducible model for teaching the skills to manage one of the most common ENT emergencies, a peritonsillar abscess or ‘quinsy’.

We have adapted the Laryngotech trainer, a well-established ENT simulation tool, to present a readily accessible, reusable and realistic simulation model.

The model provides safe training for the drainage of quinsy.

Patients with Ménière's disease can develop unaidable sensorineural hearing loss. Cochlear implantation has recently been utilised in this group with favourable results. A more challenging group are those with intractable vertigo, and they have traditionally posed a significant management dilemma.

Two female patients with unaidable hearing and recurrent incapacitating vertigo attacks despite conservative management underwent simultaneous labyrinthectomy and cochlear implantation. There was complete resolution of vertigo in both patients. Speech perception in quiet conditions and the ability to hear in background noise improved considerably.

Surgical labyrinthectomy is effective for the elimination of vertigo in Ménière's disease patients. The major disadvantage in the past was loss of residual hearing. Cochlear implantation is now an option in these patients. The benefits of simultaneous labyrinthectomy with cochlear implantation include the prevention of implantation of a fibrosed or ossified cochlea, a decrease in the duration of deafness, and a single operative procedure.

This study aimed to present and discuss the case of a patient with known glandular fever who presented with Horner syndrome.

A 35-year-old patient with known glandular fever developed acute unilateral Horner syndrome, a previously undescribed complication of this common illness. Magnetic resonance imaging and magnetic resonance angiography showed that enlarged intra-carotid sheath lymphoid tissue was likely to be the underlying cause of sympathetic nerve disruption. The case is described, the anatomy of the sympathetic chain is discussed and possible alternative pathophysiological mechanisms are reviewed.

This is the first report in the worldwide literature of Horner syndrome arising as a result of compression from enlarged lymph nodes in glandular fever.