This study aimed to determine anatomical landmarks for accurate and safe middle turn cochleostomy on cadaveric temporal bones.

In 17 cadaveric wet adult temporal bones, cortical mastoidectomy was performed, followed by extended posterior tympanotomy through which a middle turn opening was created anterior to the stapes footplate. Micro-measurements of various lengths were taken from the cochleostomy to normal middle-ear anatomical landmarks using a digital microscope.

The mean length from the middle turn cochleostomy to the processus cochleariformis was 1.8 ± 0.3 mm and to the tympanic segment of the facial nerve was 2.2 ± 0.3 mm. The mean shortest length from the oval window to the osseous spiral lamina was 2.4 ± 0.3 mm and to the internal carotid artery was 5.0 ± 0.6 mm. The mean shortest length from the round window to the internal carotid artery was 4.3 ± 0.6 mm.

A middle turn cochleostomy can be safely drilled by using the measured lengths in difficult cases.

This study aimed to analyse whether referral for specialist balance testing influences diagnosis and management of patients with dizziness.

This was a retrospective study examining patients referred for vestibular function testing between 1 January 2018 and 30 June 2018.

A total of 101 patients were referred, with 69 patients (68.3 per cent) receiving a preliminary ‘pre-vestibular function testing balance diagnosis’, which included benign paroxysmal positional vertigo (32.7 per cent), Ménière's disease (13.8 per cent) and migraine (14.9 per cent). Following vestibular function testing, revised diagnoses were achieved for 54 patients (53.5 per cent), including benign paroxysmal positional vertigo (14.9 per cent), Ménière's disease (3.0 per cent) and migraine (10.9 per cent). Pre-vestibular function testing balance diagnoses were confirmed for 32.4 per cent of patients. If no pre-vestibular function testing suspected diagnosis was provided, vestibular function testing was significantly more likely to be inconclusive. Following vestibular function testing, 38.6 per cent were discharged, 21.7 per cent were referred to another specialty and treatment was commenced for 17.8 per cent of patients.

Referral for vestibular function testing has a role when attempting to answer a clear clinical question. Diagnosing the underlying aetiology of complex imbalance is challenging, but diagnosis can be assisted by judicious use of vestibular function testing.

Auditory implantation into the inner ear is increasingly performed for a variety of indications. Infective complications are rare, but when they occur they can have devastating consequences.

This paper reports two cases where vestibular sequestration of the bony labyrinth developed following implantation into the middle ear.

To the authors' knowledge, these are the first reported cases where vestibular sequestration has resulted from auditory implant surgery. This paper outlines the radiological changes characteristic of this pathology. It also describes the surgical and conservative treatment options for this condition, challenging the previously accepted belief that affected patients always require aggressive surgical intervention.

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.

Lyme disease is an uncommon tick-borne multisystemic infection caused by Borrelia burgdorferi. The most common clinical manifestation is erythema migrans. In this report, a very unusual presentation of this condition is described, in which sudden onset sensorineural hearing loss was the sole presenting symptom.

Case report and review of English-language literature.

A patient presented with sensorineural hearing loss, with no other symptoms or signs. Acute Lyme infection was detected by laboratory tests. Magnetic resonance imaging showed signs of labyrinthitis of the same inner ear. After hyperbaric oxygen and systemic antibiotic treatment, the patient showed total hearing recovery, and magnetic resonance imaging showed complete resolution of the labyrinthitis.

To our knowledge, this is the first reported case of Lyme disease presenting only with sensorineural hearing loss. Borreliosis should be considered as an aetiological factor in sensorineural hearing loss. Adequate treatment may provide total recovery and prevent more severe forms of Lyme disease.