We present the first reported case of a middle-ear lipoma presenting with facial nerve palsy. We review the available literature on middle-ear lipomas and alert the surgeon to the possibility of a lipoma occurring in this location.

A 33-year-old man presented to our unit with a right-sided, House–Brackmann grade two, lower motor neurone facial palsy. A computed tomography scan revealed abnormal soft tissue in the epitympanic recess, extending to the region of the geniculate ganglion. At middle-ear exploration, a lump of fatty tissue was found filling the anterior middle-ear cleft, juxtaposed to the horizontal portion of the facial nerve. The patient's facial palsy resolved within a few weeks of surgery.

Lipomas are a rare but real differential diagnosis of a mass in the middle ear. Early imaging is advised.

This study aimed to elucidate the potential inner-ear effects of fotemustine, a chemotherapeutic agent which crosses the blood–brain barrier and is used in the treatment of primary and metastatic brain tumours and metastatic melanoma.

This study utilised distortion product otoacoustic emissions and transmission electron microscopy in order to conduct electrophysiological and morphological assessments, using a rat experimental model. Twelve ears of six male rats were examined two months following intraperitoneal slow infusion of fotemustine (100 mg/m2 or 7.4 mg/kg). Pre- and post-treatment measurements were compared. Finally, electron microscopy was performed on three rat temporal bones.

After infusion of fotemustine, distortion product otoacoustic emissions revealed a significant reduction in signal-to-noise ratios only at 3600 Hz (from 11.95 ± 7.52 to −0.26 ± 9.45 dB) and at 3961 Hz (from 18.09 ± 7.49 to 6.74 ± 12.11 dB) (referenced to 2f1 − f2). Transmission electron microscopy of the temporal bone revealed ultrastructural changes in the outer hair cells, stria vascularis and cochlear ganglion at the cochlear basal turn. The ganglion cell perikarya were unaffected.

Fotemustine was administered via intraperitoneal slow infusion in a rat experimental model. Twelve ears of six survivors, from 10 rats, were evaluated at the second month. Fotemustine was determined to have a potential for ototoxicity at 3600 and 3961 Hz. Three randomly chosen rats underwent electron microscopy for morphological analysis. Morphological effects in the cochlear basal turn were observed. Oedematous intracytoplasmic spaces and perivascular areas of the stria vascularis, as well as distorted chromatin content, were detected, thereby suggesting potential ototoxic effects for this agent. Further experimental and clinical studies are required in order to determine whether the effect seen in this pilot study is reversible, and to analyse effects in humans.

The objective of this study was to identify a pattern of signs, symptoms and neuroradiological findings which would assist investigation of vestibular function (especially otolith function) in a group of adult patients with anatomical alterations of the endolymphatic aqueduct and sac.

Fifteen subjects affected by volumetric abnormalities of the vestibular aqueduct were selected from a cohort of patients referred to a tertiary referral neurotological centre between 1 January 2004 and 30 June 2006. All patients underwent accurate clinical history-taking and were evaluated using a standardised set of bedside and instrumental neurotological tests (i.e. audiometry, auditory brainstem response and vestibular evoked myogenic potentials). After these tests, each patient underwent computed tomography and magnetic resonance imaging in order to accurately evaluate the middle ear, labyrinthine capsule and internal auditory canals. These evaluations confirmed clinical suspicion of volumetric abnormalities of the vestibular aqueduct and endolymphatic sac.

All the patients with a defined volumetric alteration in the region of the vestibular aqueduct and endolympatic sac reported a typical pattern of symptoms and signs. The most obvious and frequent symptoms in these patients were migraine-related vertigo (using the Neuhauser criteria, 10 of 15, 66.6 per cent), ‘motion sickness’ (12 of 15, 80 per cent), oscillopsia (nine of 15, 60 per cent) and dizziness (14 of 15, 93.3 per cent). Clinical examination results for the selected patients allowed some useful speculative conclusions. During neurotological evaluation, two instrumental methodologies were especially useful diagnostically: vestibular evoked myogenic potentials of the neck, and the mastoid vibration test at 100 Hz.

Dysfunction of the vestibular aqueduct is suggested by symptomatology characterised by: migraine-related vertigo, unstable or recurring oscillopsia, lowering of the vestibular evoked myogenic potential threshold, hypoacusis, anamnestic report of motion sickness, and nystagmus induced by mastoid vibration and head-shaking. Computed tomography and magnetic resonance imaging are needed in order to confirm clinical suspicions.

To quantitatively evaluate the diagnostic accuracy of diagnostic tests for immunomediated hearing loss.

We searched Medline and the Cochrane Database of Systematic Reviews for potentially relevant studies.

Twenty-five studies met the inclusion criteria of this systematic review. The diagnosis of immunomediated hearing loss was based on the clinical presentation and the response to corticosteroid administration.

The following data were extracted from the selected studies and entered into a standardised database: population demographics; exclusion and inclusion criteria; diagnostic tests; sensitivity; specificity; the number of true positive, true negative, false positive and false negative values; therapy used, including dose and duration; and delay between symptom onset and therapy commencement.

This systematic review combined data from 679 patients with immunomediated hearing loss, reported by 22 research teams. Substantial heterogeneity was found among the included studies; for this reason, summary sensitivity and specificity values were not computed.

The results of diagnostic tests for immunomediated hearing loss depend on many factors, and there is a risk of potential bias. This is the first time that such a systematic review has been presented; such a review is a more rigorous method of demonstrating the utility of the available diagnostic tests.

The influence of congenital cytomegalovirus infection on cochlear function has been well recognised; however, its impact on the vestibular system in infants has not been examined. The purpose of the present study was to evaluate vestibular function in a group of infants, using caloric stimulation tests and vestibular-evoked myogenic potential measurements.

Vestibular-evoked myogenic potentials and auditory brainstem responses were recorded and caloric stimulation was performed in 66 infants aged three months, comprising 40 healthy controls and 26 infants with congenital cytomegalovirus infection.

No reaction to caloric stimulation was elicited from 16 examined ears, no vestibular-evoked myogenic potentials were recorded from 12 ears, and profound sensorineural hearing loss was diagnosed in eight ears. Pathological results were observed predominantly in infants with symptoms of intrauterine congenital cytomegalovirus infection present at birth.

In infants with clinical symptoms of congenital CMV infection present at birth, abnormal vestibular test results occurred more frequently than abnormal auditory brainstem response results. Vestibular organs should be routinely examined in individuals with congenital cytomegalovirus infection.

There is a paucity of evidence to guide the post-operative follow up of patients undergoing middle-ear ventilation tube insertion for the first time. This study was conceived to identify current practice at our institution (Ninewells Hospital, Dundee) and to inform subsequent change in our follow-up procedure.

Two cycles of data collection and analysis were performed. All paediatric patients undergoing ventilation tube insertion for the first time were identified. Patients who had previously undergone ventilation tube insertion or additional procedures such as adenoidectomy or tonsillectomy were excluded. The first data collection period comprised all of the year 2000, and the second 18 months over 2003–2004. A minimum of 20 months' follow up was allowed for. Data regarding clinical findings and audiometry were recorded at each follow-up appointment.

We identified a total of 50 patients meeting our criteria for inclusion in the first cohort. There were a total of 156 appointments between surgery and data collection (a mean of 3.12 per child). A total of 113 (72 per cent) appointments lead to no medical intervention. The only statistically significant difference between patients requiring further ventilation tube insertion (n = 10) and those not requiring further treatment during the study period (n = 40) was the average hearing threshold (p < 0.01). These findings prompted a change in the post-operative regime; all patients undergoing ventilation tube insertion were subsequently seen at three months for a pure tone audiogram, and further review depended on clinical and audiometric findings. Records for 84 children were identified and collected for the second cohort, there were a total of 154 appointments (a mean of 1.83 per child). In only 18 appointments (12 per cent) were normal findings and hearing recorded and children given a further review appointment. Sixteen of 29 (55 per cent) children with abnormal clinical findings (otorrhoea, tube blockage or extrusion) required some form of intervention (p < 0.05). Twenty-six had a mean hearing threshold worse than 20 dB at first review. Nineteen (73 per cent) required further intervention of some sort (p < 0.01).

Our study demonstrated that the vast majority of review appointments resulted in no clinical intervention. We therefore question the need for regular follow up in this patient group. Twenty per cent (10 of 50 and 18 of 84) of our patients required further ventilation tube insertion within the study periods. This is consistent with rates reported in the literature. Children with abnormal clinical findings or a mean hearing threshold greater than 20 dB were significantly more likely to require further intervention. We would recommend one post-operative review with audiometry, three months after surgery. At this initial appointment, further review should be offered to those children with poor hearing, early extrusion, blockage or infection, as they are more likely to require further ventilation tube insertion. This strategy is dependent on good links with community primary care providers and easy access to secondary care for further management, should this be required.

To assess the five-year outcome of the use of single-flanged tympanostomy tubes in children, including the time to extrusion, rate of retained tubes and rate of persistent perforation.

The medical records relating to 640 single-flanged tympanostomy tubes intended for short-term use in paediatric patients were retrospectively reviewed.

We found that 36.4 per cent of the tubes had extruded within 12 months and 71.0 per cent within 24 months. Results showed that 14.1 per cent of the tubes had been removed because of prolonged retention, with a mean time to removal of 38.9 months. The time to extrusion was longer and the rate of retained tubes was higher than those reported for several other short-term tubes. We found that 4.5 per cent of tube insertions had resulted in a persistent perforation, a higher percentage than previously reported for other tubes intended for short-term use. Within five years of tube insertion, 70.5 per cent of the tympanic membranes had normalised.

Nasal polyposis is one of the most common inflammatory pathologies of the nasal cavity. The aetiopathogenetic mechanisms of nasal polyp formation are still unclear.

The aim of this study was to investigate the serum leptin levels in patients with nasal polyposis.

A randomised, prospective study was performed of 28 adult patients with nasal polyposis and 22 control subjects of a similar age, sex and body mass index.

Serum leptin levels were 12.10 ± 9.39 ng/ml in the nasal polyposis patients and 6.17 ± 7.68 ng/ml in the controls. A significant difference (p = 0.021) was observed in the mean serum leptin levels between nasal polyposis patients and controls.

Serum leptin levels were found to be significantly higher in patients with nasal polyposis. Leptin, apart from its primary role in the regulation of body weight and energy expenditure, may have a role in the inflammatory response of nasal polyposis.

To document the results of endoscopic orbital decompression performed in a group of patients with thyroid eye disease in order to improve cosmesis.

A retrospective case review was performed of all patients who had undergone endoscopic orbital decompression for cosmesis in our departments during the period January 1996 to September 2002. A postal questionnaire was sent to all patients who had undergone the operation, in order to assess patient satisfaction.

Twenty orbits of 15 patients underwent endoscopic decompression. For all orbits, the reduction in proptosis was 3.7±2.2 mm (mean±standard deviation; t = 6.5, p = 0.001). For 16 of the endoscopic decompressions (89 per cent), patients reported that they were satisfied with the appearance of their eye post-operatively, and all patients reported a reduction in eye prominence post-operatively.

Endoscopic decompression is an effective procedure for improving cosmesis in patients with inactive thyroid eye disease.

To highlight the difficulty in making a correct diagnosis of benign schwannoma in the paranasal region, to raise awareness of this rare condition, and to suggest the most appropriate treatment.

Retrieval of cases retrospectively from archives of the histopathology department of a major UK cancer centre with central review of all cases.

Five cases were identified since 1990 and clinical and pathological features are summarised. Median follow up of patients was 8.1 years. Radiological appearances of local bone invasion and histological features of tumour unencapsulation and hypercellularity could give the mistaken impression of malignant disease and lead to unnecessary over-treatment.

Central pathological review and clinical awareness is required. Although local recurrence can occur, the prognosis is excellent. The treatment of choice is local excision. Radiotherapy can be considered, but in most cases it would incur unnecessary morbidity.

Laryngopharyngeal reflux is increasingly being implicated in several otolaryngological disorders.

To study a potential correlation between pre-operative laryngopharyngeal reflux and wound healing and recovery after tonsillectomy, based on subjective and objective findings.

A prospective, blinded study was undertaken, including 60 patients scheduled for tonsillectomy, divided into two equal groups: a study group (group A) with pre-operative laryngopharyngeal reflux documented using ambulatory 24-hour pH monitoring; and a control group (group B) without laryngopharyngeal reflux.

Group A had significantly higher pain scores on the seventh and 14th post-operative days (p = 0.022 and p = 0.000, respectively) and took a significantly longer time to return to normal eating (p = 0.013), compared with group B. Group A also showed significantly slower healing on the seventh and 14th post-operative days, as estimated by assessing the grade of post-operative slough formation (p = 0.016 and p = 0.029, respectively). A significant correlation between the number of pharyngeal reflux episodes and the degree of post-operative slough was also found.

Laryngopharyngeal reflux can significantly decrease wound healing following tonsillectomy. Therefore, pre-operative recognition and management of this condition is desirable in order to eliminate its negative post-operative effect.

We aimed to evaluate the accuracy of ultrasonography, radioactive iodine uptake and serum thyroid-stimulating hormone level in predicting the volume of remnant thyroid gland.

Sixty-six thyroidectomy patients were divided into two groups according to their functional status, i.e. those operated upon for nontoxic multinodular goitre (group one) and those operated upon for hyperthyroidism (group two). Ultrasonography, radioactive iodine uptake and thyroid-stimulating hormone assay were performed in all patients during the first post-operative month. The two groups were subdivided according to the amount of remnant thyroid volume detected on ultrasonography: <2 ml, 2–5 ml and >5 ml.

The remnant thyroid volume was positively correlated with the radioactive iodine uptake (rs = 0.684, p = 0.0001). The increase in remnant thyroid tissue radioactive iodine uptake was significantly greater in the patients operated upon for hyperthyroidism compared with those operated upon for nontoxic multinodular goitre (p = 0.0001). There was a negative correlation between remnant thyroid volume and post-operative serum thyroid-stimulating hormone level (rs =  −0.865, p = 0.0001) and between remnant thyroid tissue radioactive iodine uptake and post-operative serum thyroid-stimulating hormone level (rs = −0.682, p = 0.0001).

Ultrasonography is a more accurate measure of remnant thyroid volume than radioactive iodine uptake in patients operated upon for hyperthyroidism, compared with those operated upon for nontoxic multinodular goitre.

We report a method of inserting a T-tube.

A 14-G branula and a T-tube are used.

This method was found to be simple and required few instruments.

To the best of our knowledge, this method has not previously been reported.

We report a case of a 58-year-old man suffering from stiff-person syndrome and recurrent peripheral vertigo.

A case report and a review of the recent literature on stiff-person syndrome are presented.

The patient presented with recurrent episodes of vertigo with a pure peripheral pattern and with concomitant episodes of burning muscle pain, muscle twitching, weight gain and fatigue, worsening with tension or stress that also occurred in periods without vertigo. Cochlear examinations only showed presbyacusis-like hearing loss. The diagnosis of stiff-person syndrome was made with electromyographic examination and from findings in the blood and cerebrospinal fluid of high titres of anti-glutamic acid decarboxylase (GAD67) autoantibodies. In a two-year follow-up period, therapy for stiff-person syndrome abolished episodes of both stiffness and vertigo.

As far as we know, no other clinical case of acute vestibular damage with a possible correlation with anti-glutamic acid decarboxylase antibodies has been described. Peripheral vertigo possibly related to a lack of gamma aminobutyric acid underlines a possible role of gamma aminobutyric acid as a neurotransmitter in the peripheral vestibular system.

Acute sinusitis is a relatively common condition, which usually responds to medical therapy. In most cases, there are no sequelae or complications subsequent to this infection. However, like many acute illnesses, there are well documented complications of acute sinusitis, and in particular these include peri-orbital and intracranial spread.

The purpose of this paper is to highlight the importance of vigilance in peri-orbital involvement and the limitations of imaging techniques, such as computed tomography scanning. An illustrative case is presented to demonstrate this.

Magnetic resonance imaging scanning is a valuable modality in assessing complex presentations of peri-orbital complications of acute sinusitis.

Metastasis of squamous cell carcinoma to the neck with an occult primary is a recognised clinical and pathological entity. Despite well established diagnostic protocols, this condition still represents a management challenge.

We report the case of a 46-year-old man who presented with metastatic cervical lymphadenopathy of unknown origin. He had undergone tonsillectomy as a child. The only abnormal finding was the presence of a tonsillar remnant, which harboured the primary carcinoma.

According to our literature search, this is the only recorded case in which the index tumour was found in a tonsillar remnant. This case illustrates the importance of thorough clinical examination in patients with potential unknown primaries, and of the need, in previously tonsillectomised patients, to perform excisional biopsy of the tonsillar remnant.