To analyse the clinical presentation, treatment and outcome in patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria.

A retrospective case review of 16 patients diagnosed with otomastoiditis caused by non-tuberculous mycobacteria from 2000 to 2012 was conducted in a hospital and tertiary referral centre in Sweden. The main outcome measures were microbiology findings, and surgical and medical interventions and outcomes. In addition, the relevant literature was reviewed.

In three patients with otomastoiditis, the disease had spread intracranially. The bacteriological findings revealed Mycobacterium abscessus (n = 12), Mycobacterium fortuitum (n = 2) and Mycobacterium avium complex (n = 2). Surgical treatment was undertaken in all but three patients, including exploration of the temporal lobe in one patient. Systemic antibiotic treatment was given to all but one patient. Eight patients healed completely. Eight patients developed hearing loss. Two patients had relapse of the mycobacterial infection several months after the antibiotic treatment had been discontinued.

Non-tuberculous otomastoiditis is a severe ear disease with challenging considerations, and should be treated aggressively in order to avoid morbidity.

Our aim was to determine if stapes surgery is useful for treating inflammatory ear diseases.

Thirteen patients underwent single-stage or staged surgery for stapes fixation due to tympanosclerosis alone or with cholesteatoma. Operative criteria were: no tympanic membrane retraction, perforation or adhesion; middle-ear cavity with aeration >1 year; a fixed stapes. Computed tomography was used to analyse the relation between operative success and pre-operative pneumatisation.

Success rate at six months was 75 per cent. Hearing results were stable with little deterioration and no complications. Patients with poor pneumatisation had good results (with improved air–bone gap) only after staged surgery. Well-aerated ears heard better even with single-stage surgery.

Pre-operative computed tomography and intra-operative findings are necessary to determine the pneumatisation status of tympanic mastoid cavities. If criteria approved, poorly pneumatised patients underwent staged surgery. Stapedectomy achieved good hearing results for inflammatory middle-ear disease with stapes fixation.

This study was conducted to investigate the angles and orientation of semicircular canals, and the coplanarity of functional canal pairs.

Fluid signals in semicircular canals were reconstructed with three-dimensional reconstruction software using 20 temporal bone magnetic resonance images of normal subjects. The angles between each pair of semicircular canals were measured.

The mean angles between the anterior and horizontal semicircular canal plane, the horizontal and posterior semicircular canal plane, and the anterior and posterior semicircular canal plane were 83.7°, 82.5° and 88.4°, respectively. Pairs of contralateral synergistic canal planes were formed 15.1° between the right and left horizontal semicircular canal planes, 21.2° between the right anterior and left posterior semicircular canal, and 21.7° between the left anterior and right posterior semicircular canal.

Each semicircular canal makes an almost right angle with other canals, but synergistically acting functional canal pairs of both ears do not lie in exactly the same plane.

To present the profile of patients undergoing surgical treatment for vertigo at a contemporary institutional vertigo clinic.

A retrospective analysis of clinical charts.

The charts of 1060 patients, referred to an institutional vertigo clinic from January 2003 to December 2012, were studied. The clinical profile and long-term outcomes of patients who underwent surgery were analysed.

Of 1060 patients, 12 (1.13 per cent) were managed surgically. Of these, disease-modifying surgical procedures included perilymphatic fistula repair (n = 7) and microvascular decompression of the vestibular nerve (n = 1). Labyrinth destructive procedures included transmastoid labyrinthectomy (n = 2) and labyrinthectomy with vestibular nerve section (n = 1). One patient with vestibular schwannoma underwent both a disease-modifying and destructive procedure (translabyrinthine excision). All patients achieved excellent vertigo control, classified as per the American Academy of Otolaryngology – Head and Neck Surgery 1995 criteria.

With the advent of intratympanic treatments, surgical treatments for vertigo have become further limited. However, surgery with directed intent, in select patients, can give excellent results.

Pharyngeal pouches have been recognised as a cause of dysphagia for centuries and have been treated in a variety of ways over that time.

This article aimed to analyse the results of surgery by a variety of techniques, as performed by one surgeon.

A retrospective analysis of a case series was conducted, analysing the variables of patient age, sex, type of surgery, length of hospital stay, leak, recurrence and other complications.

A total of 121 patients were treated by 135 operations. There were no leaks in the group treated by endoscopic stapling and this group also had a significantly shorter hospital stay. As for recurrence, the lowest rate appeared to be in the group treated by excision of the pouch.

The techniques used by the author all still seem to have a role in the management of pharyngeal pouch, with the endoscopic stapling approach associated with a low rate of complications and short hospital stay.

The British Society of Audiology has produced clear guidelines as to how otoscopy should be undertaken; however, no nationally recognised guidelines exist for the wider clinical community. Images of otoscopy appear in many books, journals, magazines and websites.

This study aimed to determine the rate of non-compliance with good practice in images of otoscopy, the seriousness of the breach, and whether this is more common in sites for professionals or the general public.

Google Images was searched using the terms ‘otoscopy’ and ‘ear examination’. A total of 200 images were identified and collated. The images were reviewed for compliance with good practice standards.

Only 12.75 per cent of the images were graded as having no breach of good practice standards.

Professional websites have a responsibility to show best practice. When choosing an image, the source of the image needs to be carefully considered.

Central skull base osteomyelitis is clinically difficult to distinguish from malignancy.

The computed tomography and magnetic resonance imaging scans of six patients with central skull base osteomyelitis were compared with scans from patients with a range of skull base conditions.

Computed tomography scans of central skull base osteomyelitis show much less bony destruction relative to the magnetic resonance imaging changes, whereas malignancy cases were associated with similar bony destruction on computed tomography and magnetic resonance imaging. In magnetic resonance imaging scans, it was possible to confirm previous findings of clival hypointensity on T1-weighted images relative to normal fatty marrow. In addition, there were signs of pre- and para-clival soft tissue infiltration, with the obliteration of normal fat planes and frank soft tissue masses in all six central skull base osteomyelitis patients. Signal intensity on T2-weighted images of the clivus was high in five central skull base osteomyelitis patients. With intravenous contrast, fascial plane anatomy appeared restored in central skull base osteomyelitis cases, almost in keeping with that of non-involved areas. This was not a feature in any of the malignant conditions.

To determine the relationship between severe tinnitus and inflammation using the neutrophil-to-lymphocyte ratio as a marker of stress.

A total of 107 patients who had been suffering with severe tinnitus (tinnitus handicap inventory scale grades of 3–5) for at least 2 weeks were recruited. Patients underwent detailed ENT examinations and audiometric tests to exclude a relevant pathological cause of the tinnitus. Patients with systemic diseases, malignancy or inflammatory diseases that could alter neutrophil-to-lymphocyte ratio were excluded. A total of 107 age- and sex-matched healthy control participants were also recruited. Routine laboratory test results and neutrophil-to-lymphocyte ratio were compared between the patients and controls.

Lipid profile, liver function, white blood cell count, haemoglobin level, mean corpuscular volume, and vitamin B12 and folate levels were similar among the patients and controls. However, mean neutrophil-to-lymphocyte ratio was significantly higher among the patients than the controls (p < 0.05).

The findings of this novel study suggest that neutrophil-to-lymphocyte ratio should be considered during the evaluation of tinnitus patients as a potential clinical marker of tinnitus. Further studies are required to verify the findings.

Fifty per cent of children with serous otitis media may have some balance disturbances.

To evaluate vestibular function in children with otitis media with effusion.

The control group comprised 25 children with bilateral normal hearing and middle-ear function. The study group consisted of 30 children with bilateral otitis media with effusion; these were divided into 2 subgroups according to air–bone gap size. Measures included the Arabic Dizziness Handicap Inventory, an imbalance evaluation sheet for children, vestibular bedside tests for children, and air- and bone-conducted vestibular-evoked myogenic potential testing.

Arabic Dizziness Handicap Inventory scores and some vestibular bedside test results were significantly abnormal, with normal video-nystagmography results, in children with otitis media with effusion. Air-conducted vestibular-evoked myogenic potentials were recorded in 73 per cent of children with otitis media with effusion, with significantly delayed latencies. Bone-conducted vestibular-evoked myogenic potentials were successfully detected in 100 per cent of children with otitis media with effusion with similar results to the control group.

The Arabic Dizziness Handicap Inventory and vestibular bedside tests are valuable tools for detecting vestibular impairment in children. Bone-conducted vestibular-evoked myogenic potentials are useful for vestibular system evaluation.

Panendoscopy is routinely used for the identification of occult second primary tumours in head and neck squamous cell carcinoma. However, its role in low risk subgroups, particularly non-smoking, non-drinking patients and patients presenting with early stage oral cavity lesions, is debatable.

The records of 112 patients with T1 or T2 oral tongue squamous cell carcinoma were retrospectively reviewed. Demographic, disease characteristics and survival data were collected.

Average follow-up duration was 71.7 months (range, 3.6–238.3 months). Thirty-five patients died within this period. Thirteen second primary events were identified in 11 patients, with all but 2 tumours in the oral cavity or oropharynx. There was a single synchronous primary – a lung adenocarcinoma; all other events were metachronous. No non-smoking, non-drinking patients re-presented with a second primary tumour; tobacco and alcohol use are clearly risk factors for development of a second primary tumour.

The role of panendoscopy for identifying synchronous primary tumours in patients with early stage oral tongue squamous cell carcinoma should be re-evaluated, particularly in non-smoking, non-drinking patients who are at low risk of second primary development. Close follow up with regular clinical examination including flexible fibre-optic endoscopy may be sufficient in this subgroup.

Coblation tonsillectomy can be controversial. This study assessed post-tonsillectomy haemorrhage outcomes for patients operated on by a single experienced coblation-trained ENT surgeon.

A retrospective audit of coblation tonsillectomies was performed using the Flinders modification of Stammberger criteria for post-tonsillectomy haemorrhage.

Case note review, interview and database interrogation were utilised to obtain the dataset. Haemorrhage results were compared to reports in the current literature.

Of those who underwent coblation tonsillectomy, 3.4 per cent were readmitted to hospital with haemorrhage and 1.3 per cent returned to the operating theatre (0.4 per cent primary haemorrhage and 0.9 per cent secondary haemorrhage). Younger children had a lower risk of returning to the operating theatre than older children or adults (0.3 per cent under the age of 12 years vs 2.0 per cent aged 12 years or older).

Coblation can be a safe method for tonsillectomy with low complication rates when performed by an experienced ENT surgeon. The Flinders modification of the Stammberger criteria for post-tonsillectomy haemorrhage provides a simple system for data comparison.

The use of endoscopic techniques is becoming more widespread in otological and neuro-otological surgery. One such procedure, endoscopic tympanoplasty, is used in chronic otitis media treatment. This study aimed to analyse the results of endoscopic transcanal cartilage tympanoplasty.

Data of tubotympanic chronic otitis media patients who underwent transcanal endoscopic type I cartilage tympanoplasty between June 2012 and May 2013 were analysed. The main outcome measures were graft success and hearing improvement.

Graft success rates were 94.3 per cent and 92.5 per cent at post-operative months one and six, respectively. Post-operative air–bone gap values were significantly improved over pre-operative values (p < 0.01).

Transcanal endoscopic type I cartilage tympanoplasty is a minimally invasive, effective and reliable surgical treatment option for chronic otitis media.

This study aimed to assess the long-term outcome of functional endoscopic sinus surgery for Samter's triad patients using an objective visual analogue scale and nasal endoscopy.

Using a retrospective database, 33 Samter's triad patients who underwent functional endoscopic sinus surgery were evaluated pre- and post-operatively between 1987 and 2007 in Hospital of La Chaux-de-Fonds, Switzerland.

A total of 33 patients participated in the study, and the mean follow-up period was 11.6 years (range 1.2–20 years). Patients were divided into two groups based on visual analogue scale scores of the five parameters with the greatest difference in intensity of symptoms between the beginning and end of follow up. Group 1 included patients with a mean visual analogue scale score of 6 and below at the end of follow up and group 2 included patients with a mean visual analogue scale score of more than 6. The only statistically significant difference noted between the two groups was the endonasal findings: stage III–IV polyposis was present in 1 out of 24 patients (4 per cent) in group 1 and in 5 out of 9 patients (56 per cent) in group 2.

The results of our study indicate that functional endoscopic sinus surgery helps stabilise disease progression. Stage III–IV polyposis had a significant adverse effect on long-term outcome.

Benign paroxysmal positional vertigo is a common vestibular disorder that negatively affects an individual's health-related quality of life. This study aimed to examine the effectiveness of the Parnes particle repositioning manoeuvre as an intervention for individuals with posterior canal benign paroxysmal positional vertigo.

The de-identified records of 155 individuals treated with the Parnes manoeuvre were examined. Descriptive statistics were calculated, including the frequency and valid per cent of participants whose nystagmus was resolved with the Parnes manoeuvre.

In all, nystagmus was resolved with the Parnes manoeuvre in 145 participants (93.5 per cent). The mean number of manoeuvres needed to resolve the nystagmus was 1.3.

The Parnes manoeuvre proved to be as effective as the Epley canalith repositioning manoeuvre, currently the most common intervention, in treating individuals with posterior canal benign paroxysmal positional vertigo.

To analyse the radiological features of the bony nasolacrimal duct before and after functional endoscopic sinus surgery, and document the incidence of surgically induced dehiscence.

A retrospective case series analysis was conducted of 63 consecutive patients who underwent uncinectomy as a part of 118 functional endoscopic sinus surgical procedures. All patients underwent pre- and post-operative computed tomography scans. Axial computed tomography images at the level of maxillary sinus were evaluated for the presence of bony nasolacrimal duct dehiscence, osteitis and completeness of uncinectomy.

The rate of nasolacrimal duct dehiscence prior to surgery was 6.8 per cent (8 out of 118 cases). Nasolacrimal duct dehiscence as a consequence of surgery was observed in 3.3 per cent of cases (4 out of 118), with a further 4.2 per cent (5 out of 118) showing post-operative reactive bony change of the nasolacrimal duct in the absence of dehiscence.

The incidence of nasolacrimal duct injury observed was much lower than that previously reported in the literature.

Cartilage-perichondrial grafts are often used for tympanic membrane and middle-ear reconstructions. Tragal and conchal cartilages are most frequently used for this purpose. Studies have shown that slicing the cartilage to less than 0.5 mm thickness improves acoustic benefit. However, the thickness of the cartilage in a given population may not be uniform.

This descriptive cross-sectional study aimed to determine the average thickness of tragal cartilage (in terms of age and sex) in an Indian population.

A prospective study of 61 tragal cartilages harvested during serial tympanoplasty and modified radical mastoidectomy were analysed according to thickness.

The total average thickness of tragal cartilage was 1.228 ± 0.204 mm in males and 1.090 ± 0.162 mm in females. The overall thickness was 1.018 ± 0.139 mm in those aged less than 15 years, 1.139 ± 0.238 mm in those aged 15–30, and 1.189 ± 0.155 mm in those aged over 30 years.

The findings help us to determine age-related cartilage thickness for slicing techniques in tympanoplasty.

To examine the relationship between pre-operative electronystagmography and videonystagmography test results and post-operative outcomes in dizziness, auditory sensitivity and speech recognition.

A retrospective chart review was performed. Auditory sensitivity and speech perception ability were tested pre- and post-operatively in 37 adult cochlear implant recipients. Auditory sensitivity was evaluated using either pure tones (for testing with earphones) or frequency-modulated warble tones (for sound-field testing). Speech perception ability was evaluated using Northwestern University Auditory Test Number 6.

No correlation was found between pre-operative electronystagmography test results and post-operative subjective dizziness. However, pre-operative electronystagmography testing and post-operative hearing sensitivity as measured by warble tone average (dB HL) correlated significantly at six months or later after cochlear implant activation (r  ≥  −0.34, n = 34, p < 0.05).

This study, which has a level of evidence 4, demonstrates that pre-operative electronystagmography testing has a potential use in predicting post-operative outcomes in hearing sensitivity following cochlear implantation. However, larger studies are needed to confirm this novel finding.

To compare the incidence of sensorineural hearing loss between those treated with docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by carboplatin concurrent chemoradiotherapy and those treated with conventional concurrent chemoradiotherapy for advanced nasopharyngeal carcinoma.

Serial pure tone audiometry was conducted in 36 nasopharyngeal carcinoma patients who were randomised into 2 groups. The first group received docetaxel, cisplatin and 5-fluorouracil induction chemotherapy followed by carboplatin concurrent chemoradiotherapy. The second group received conventional concurrent chemoradiotherapy.

The incidence of sensorineural hearing loss at speech frequency in the first group was 10 per cent and in the second group was 50 per cent (p = 0.0027). Bone conduction thresholds were significantly increased after completion of the treatment at 2–4 kHz in the first group and at all frequencies in the second group.

The docetaxel, cisplatin and 5-fluorouracil induction chemotherapy regimen followed by concurrent chemoradiotherapy was associated with a lower incidence of sensorineural hearing loss than conventional concurrent chemoradiotherapy. This regimen may be the preferred choice of treatment for hearing preservation.

To study the possible damage to the vestibular system in patients with post-mumps sensorineural hearing loss.

Nineteen patients with recent mumps infection participated in the study. All patients had unilateral profound sensorineural hearing loss or total hearing loss. Patients were subjected to video-nystagmography and vestibular-evoked myogenic potential testing.

Eight patients (42.1 per cent) had normal video-nystagmography results and intact vestibular-evoked myogenic potentials on both sides, whereas the other 11 patients (57.9 per cent) had vestibular lesions in the form of marked canal weakness and absent vestibular-evoked myogenic potential responses on the same side as hearing loss. The overall findings indicated a peripheral site for the lesions.

The majority of patients with post-mumps sensorineural hearing loss had peripheral vestibular pathology in the same ear as hearing loss. Further research should be directed to saving the inner ear following mumps infection.

We investigated the ossicular movement in the near-intact middle ear in response to acoustic stimulation using a high-speed video camera and video analysis software program.

We have designed a good visual access to the middle ear of the guinea pig by opening the ventral wall of the otic capsule, without injuring the sound-conducting structures, from the external auditory canal to the oval window. The high-speed video camera could record analysable ossicular motion up to 4000 frames per second.

The stapes showed reciprocal movement in the same frequency as the stimulating tone, and with an amplitude proportional to the stimulating sound intensity. Injury to the tympanic membrane attenuated the stapedial motion, which was recovered to that of the control level by patch repair of the perforation.

Our experimental set-up was capable of evaluating the conductive hearing, regardless of the status of the animal's sensorineural hearing or even life. Such a video analysis may provide a powerful tool to investigate the physiology of the middle ear.