It is common practice to use head bandages for 7–10 days following pinnaplasty. However, head bandages are often troublesome for patients and can lead to serious complications.

A systematic review was performed to evaluate the use of head bandages after pinnaplasty. A search of Medline, Embase (Ovid) and CINAHL (EBSCO collections), the Cochrane Library, Pubmed (US National Library of Medicine) and Google Scholar identified 34 related articles. Of these, 14 were deemed relevant and 2 randomised controlled trials, 1 cohort study, 3 case series and 1 literature review met the inclusion criteria.

The two randomised controlled trials show no statistically significant difference in complications when a head bandage was used for the standard 7–10 days, for 24 hours or not at all. The three case series show that using a head bandage for 24 hours or not at all are safe alternatives. The review article recommended that when head bandages are applied after pinnaplasty it should be for the shortest duration possible.

Based on the available evidence, not using a head bandage at all or using one for a maximum of 24 hours following pinnaplasty is recommended.

To investigate the psychosocial impact of prominent ears on children, and evaluate the outcomes of otoplasty two years after surgery, using the Child Behavior Checklist to comparatively evaluate patients' psychosocial profiles.

A total of 198 otoplasty procedures were performed in 107 patients (85 per cent bilateral procedures). Otoplasty was performed solely in 86 patients and concurrently with other procedures in 21 patients. All children who underwent surgery obtained good post-operative results, with satisfactory correction of the deformity reported by the patients and their parents or guardians. There were statistically significant decreases in Child Behavior Checklist scores in the domains of: anxiety and depression (p = 0.028), social problems (p = 0.018), difficulties in thinking (p = 0.012), total behavioural problems (p = 0.012), internalising problems (p = 0.020) and externalising problems (p = 0.044), and near-significant decreases in scores for attention problems (p = 0.055) and aggressive behaviour (p = 0.078). There was a statistically significant increase in the score for total social competence (p = 0.031).

Psychological problems associated with anatomical deformities such as prominent ears can be reduced by means of appropriate corrective surgery. Psychological support is necessary for the patient.

We aimed to evaluate the clinical efficacy of ciprofloxacin plus fluocinolone acetonide (antibiotic plus corticosteroid) ear drops compared to ciprofloxacin (antibiotic) ear drops in diffuse otitis externa.

This was a multicentre, randomised, parallel-group, double-blind study involving 590 patients of both sexes aged 7 years or older.

The rate of clinical cure was higher (p = 0.01) with ciprofloxacin plus fluocinolone acetonide than with ciprofloxacin alone. The mean total symptom score was lower with ciprofloxacin plus fluocinolone acetonide (p = 0.005). No differences were found in the percentage of patients reporting resolution of otalgia between patients receiving ciprofloxacin plus fluocinolone acetonide and patients receiving only ciprofloxacin. Resolution of oedema and otorrhoea (p = 0.003 and p = 0.002, respectively) was higher with ciprofloxacin plus fluocinolone acetonide, as was eradication or presumed eradication (p = 0.003). There were eight mild adverse events, three with the ciprofloxacin plus fluocinolone acetonide combination (not related to the treatment) and five when ciprofloxacin was administered alone (directly related to the treatment).

Ciprofloxacin plus fluocinolone acetonide is a more effective treatment for diffuse otitis externa than ciprofloxacin alone. The ciprofloxacin plus fluocinolone acetonide combination also has an excellent safety profile.

There is currently a lack of robust evidence on the best form of packing for otological surgery. We describe the use of the absorbable gelatin sponge, a packing material that does not require removal and has the benefit of being considerably cheaper compared to other common forms of ear packing.

A comparison was made of the financial cost of several forms of packing for common otological procedures. In addition, a retrospective audit of complications was undertaken of all patients in whom the absorbable gelatin sponge was used over the past three years.

The absorbable gelatin sponge was shown to be cheaper to purchase per unit and also more economical to use. It has been the exclusive form of packing used in 519 procedures over the past three years at the William Harvey Hospital in Ashford (UK), with very few complications noted at the follow-up review.

We strongly advocate using the absorbable gelatin sponge, a packing material that is kinder to the patient, has similar efficacy to other forms of packing and is also much cheaper to use compared to other common forms of packing.

To demonstrate that Blu-tack is equally effective at attenuating sound as over-the-counter ear plugs.

Nineteen healthy volunteers had their hearing thresholds assessed before and after the insertion of over-the-counter ear plugs. The results were compared with hearing thresholds following the insertion of Blu-tack. Thresholds were tested at: 0.5, 1, 2, 3, 4, 6 and 8 kHz. The differences were compared, and p values of less than 0.02 were regarded as significant. Using a visual analogue scale, volunteers were asked to assess the comfort and ease of insertion of the ear plugs and Blu-tack, and their peace of mind whilst using the ear plugs and Blu-tack.

Blu-tack was less effective at attenuating sound at low frequencies, but was as effective as over-the-counter ear plugs at attenuating sound above 3 kHz. Blu-tack was significantly more comfortable to wear (p = 0.006). There was no difference in terms of ease of insertion and peace of mind.

Blu-tack can be regarded as a comfortable alternative to over-the-counter ear plugs for the attenuation of everyday sound.

We investigated lactate dehydrogenase isoenzyme patterns in the cyst fluid of auricular pseudocysts and autogenous blood, to assist the diagnosis of auricular pseudocyst.

Twenty patients with auricular pseudocysts participated in this study conducted in Kaohsiung Medical University Hospital between February 2007 and June 2010. Patterns of lactate dehydrogenase in cyst fluid and autogenous blood were analysed.

Levels of lactate dehydrogenase 1 and 2 were lower in auricular pseudocysts than in autogenous blood, whereas levels of lactate dehydrogenase 4 and 5 were higher; this difference was statistically significant (p < 0.001).

Lactate dehydrogenase isoenzyme patterns in auricular pseudocyst fluid indicated higher percentage distributions of lactate dehydrogenase 4 and 5 and lower percentage distributions of lactate dehydrogenase 1 and 2. An effective laboratory method of evaluating the different lactate dehydrogenase isoenzyme components was developed; this method may improve the accuracy of auricular pseudocyst diagnosis.

We describe a rare case of spontaneous temporomandibular joint herniation into the external auditory canal, and we also review the presentation, aetiology and management of such cases.

An 87-year-old woman presented with a four-month history of left-sided otorrhoea and otalgia. Examination revealed a soft, polypoid mass in the left ear canal. When the patient opened her mouth the lesion disappeared. Subsequent computed tomographic imaging of the patient's temporal bones confirmed an 8.6 mm defect in the antero-inferior portion of the left ear canal, with herniation of retrodiscal soft tissues.

The external auditory canal is intimately related to the temporomandibular joint, separated only by its bony anterior wall. Neoplasm, trauma or inflammation in this area can result in displacement of the temporomandibular joint into the ear canal; however, spontaneous herniation is rare. Persistence of the primitive foramen of Huschke can result in dehiscence of the anterior canal wall, allowing articular tissue to prolapse into the ear canal. Surgical closure of these defects is known to be effective in ameliorating symptomatic cases.

To raise awareness of nasal malignant melanoma, a rare tumour, and to highlight the difficulty associated with its optimum management.

Case report and literature review.

A 71-year-old, Caucasian man was diagnosed with malignant melanoma in the right nasal cavity, after presenting with right-sided epistaxis. He underwent endoscopic medial maxillectomy; histological analysis confirmed that the resection margins were clear. However, within six months he re-presented with a metastatic deposit of malignant melanoma in his right external auditory canal, for which he underwent right temporal bone resection. There was no evidence of distant metastasis on radiological studies. Unfortunately, within a month the tumour recurred in the right nasopharynx. A multidisciplinary team decision was made to offer the patient palliative chemoradiotherapy.

Mucosal malignant melanoma of the nose is very rare, and aural metastasis from this primary site has not previously been reported. Optimum management must involve a multidisciplinary team.

To establish surfers' knowledge of the preventability of external auditory canal exostoses (‘surfer's ear’), and their use of water precautions.

Survey of surfers conducted between December 2009 and March 2010 at beaches in Cornwall, UK.

Ninety-two surfers were included (78 males and 14 females, mean age 27 years, standard deviation 7.9 years). Participants were grouped according to their awareness of the preventability of surfer's ear (55 aware, 37 unaware). These groups were comparable in age, surfing history and gender mix (p > 0.05). Surfers aware of the preventability of exostoses (66 per cent) were more likely to use water precautions than those who were not (38 per cent) (p < 0.01). Two surfers used water precautions regularly and 48 used them occasionally. Sixty-one of the 76 surfers who did not use water precautions (ear plugs) suggested they would consider doing so in the future.

Awareness of the preventability of surfer's ear was associated with greater use of water precautions. Further research should explore reasons for the low uptake of such precautions. Most surfers not already using ear plugs would consider doing so in the future.

Ear lobule deformities can occur as a result of trauma. Surgical reconstruction can be challenging. There does not appear to be a consensus on the best form of repair. We report the case of a 27-year-old woman who suffered traumatic loss of the ear lobule during childhood. A novel technique is described using a posterior based bi-lobar flap to completely reconstruct the ear lobule in two stages.

This form of repair has the advantage of a well-hidden scar, with the donor site providing skin of similar thickness and pigmentation.