Minimum health requirements exist for entry into the UK armed forces. Both pre-existing and iatrogenic ENT conditions may impact on an individual's medical fitness and their ability to enter the forces.

The relevant literature was examined and military otolaryngology advisors were interviewed in order to define the ENT-specific conditions that restrict an individual joining the armed forces.

The ENT diseases and disabilities that inhibit an individual's ability to join the forces are described. Treatments that may facilitate or restrict recruitment are also discussed.

Members of the armed forces operate in arduous environments and are required to pass a screening medical assessment before joining. Personnel may be isolated away from specialist care and therefore cannot be dependent on specialist devices or medicines. This paper aims to arm ENT specialists with occupational knowledge to enable them to correctly counsel patients and offer appropriate treatment.

Olfactory dysfunction is a common condition that may in some cases require imaging to investigate a potential underlying cause.

This review describes the anatomy of normal olfaction and illustrates the pathological substrates of olfactory dysfunction amenable to imaging.

A systematic review was performed to evaluate the role and effectiveness of head bandages after routine elective middle-ear surgery.

Studies that compared the effectiveness of head bandage use after elective middle-ear surgery (e.g. myringoplasty, mastoidectomy and cochlear implantation) were identified using the following databases: Ovid Medline and Embase, the Ebsco collections, the Cochrane Library, PubMed, and Google Scholar. An initial search identified 71 articles. All titles and abstracts were reviewed. Thirteen relevant articles were inspected in more detail; of these, only five met the inclusion criteria. These included three randomised, controlled trials, one retrospective case series and one literature review.

The three randomised, controlled trials (level of evidence 1b) showed no statistically significant differences in post-operative outcomes (in terms of complications) associated with head bandage use in middle-ear surgery. This finding was supported by the retrospective case series involving patients undergoing cochlear implantation.

Current available evidence shows no advantage of head bandage use after middle-ear surgery. Head bandages may not be required after routine, uncomplicated middle-ear surgery.

To evaluate the effectiveness of tympanostomy tube placement in controlling symptoms of intractable Ménière's disease.

Fifteen patients with intractable Ménière's disease underwent tympanostomy tube placement in the affected ear. Post-operative changes in vertigo attacks and hearing level were recorded, and were evaluated according to American Academy of Otolaryngology–Head and Neck Surgery criteria.

At 12 months after treatment, 3 patients (20 per cent) showed complete control of vertigo, 7 (47 per cent) showed substantial control and 2 (13 per cent) showed limited control; 3 patients (20 per cent) required other treatment. At 24 months after treatment, 7 patients (47 per cent) showed complete control of vertigo, 3 (20 per cent) showed substantial control and 1 (7 per cent) showed limited control; 1 patient required other treatment 15 months after tympanostomy tube placement.

There is no definite pathophysiological explanation for the effect of tympanostomy tube placement in reducing vertigo attacks. This treatment is not effective for all patients with intractable Ménière's disease. However, tympanostomy tube placement might be an additional surgical therapeutic option to consider prior to contemplating other, more invasive treatments.

Surgeons regularly use eponymous instruments when performing tonsillectomies, yet the stories behind each are not commonly known.

This paper presents the instruments within the tonsillectomy tray, providing a brief biography of their respective surgeon namesakes. The list captures over two centuries of surgical history, and spans the disciplines of ENT, general surgery, gynaecology, anaesthetics and paediatric surgery.

This is the first publication to undertake a historical study of the ensemble of surgeon inventors responsible for the instruments in the tonsillectomy tray as it is today. In furthering knowledge of our forbearer surgeon inventors, who have shaped the tonsillectomy procedure as it is safely performed today, we enrich our understanding of the history of our profession and build appreciation for the instruments employed daily. We may even be inspired to continue the tradition of evolving the craft.

This study aimed to evaluate the prevalence of normal variations of temporal bone anatomy on high-resolution computed tomography imaging and report their clinical importance.

A retrospective review was conducted of high-resolution temporal bone computed tomography imaging performed at NHS Greater Glasgow and Clyde over an eight-year period. The presence of five variants was determined. These variants were: a high dehiscent jugular bulb, an anteriorly located sigmoid sinus, a deep sinus tympani, an enlarged cochlear aqueduct and a large internal auditory meatus.

A total of 339 temporal bones were examined. The incidences of a high dehiscent jugular bulb, anteriorly located sigmoid sinus, deep sinus tympani, enlarged cochlear aqueduct and an enlarged internal auditory meatus were 2.76 per cent, 2.94 per cent, 5.01 per cent, 0.58 per cent and 1.76 per cent respectively.

Anatomical variations of the temporal bone are not uncommon and it is important for the investigating otologist to be aware of such variations prior to undertaking surgery.

This study aimed to ascertain otolaryngologists’ current knowledge of new (e.g. apixaban, rivaroxaban) and old (e.g. warfarin) anticoagulant medications, and to provide an educational overview of new anticoagulants for use by surgeons.

A questionnaire survey was distributed across the Wessex region, UK, to ascertain the levels of knowledge of and confidence in managing patients taking various anticoagulants. In total, 50 questionnaires were completed (41 by trainees and 9 by consultants). A literature review of new anticoagulant medications was then conducted.

In general, there was poor clinical and pharmacokinetic knowledge of newly licensed anticoagulant medications. Respondents were more confident in the use of older vs newer forms of anticoagulants. This was true across all grades of doctors, but particularly at the senior level. All respondents stated that they would like to see an educational resource on anticoagulants.

Knowledge of newly licensed anticoagulation medications is poor. This study has produced an educational resource for the management of anticoagulant agents. A thorough knowledge of these drugs is essential for the acute management of bleeding patients and in peri-operative surgical planning.

This paper attempts to chart the history of head and neck cancers and their surgical treatment, starting from ancient Egypt and concluding with Galen.

The ancient Egyptians appear to have treated head and neck cancers with local applications. The ancient Greek corpus contains a reference to treating pharyngeal carcinoma with cautery, but the description is too vague to establish the diagnosis conclusively. The ancient Romans moved away from surgical treatments, with Galen establishing a prejudice against surgery that would last through the Middle Ages.

This study aimed to compare the efficacy of diode laser, coblation and cold dissection tonsillectomy in paediatric patients.

A total of 120 patients aged 10–15 years with recurrent tonsillitis were recruited. Participants were prospectively randomised to diode laser, coblation or cold dissection tonsillectomy. Operative time and blood loss were recorded. Pain was recorded on a Wong–Baker FACES® pain scale.

The operative time (10 ± 0.99 minutes), blood loss (20 ± 0.85 ml) and pain were significantly lower with coblation tonsillectomy than with cold dissection tonsillectomy (20 ± 1.0 minutes and 30 ± 1.0 ml; p = 0.0001) and diode laser tonsillectomy (15 ± 0.83 minutes and 25 ± 0.83 ml; p = 0.0001). Diode laser tonsillectomy had a shorter operative time (p = 0.0001) and less blood loss (p = 0.001) compared with cold dissection tonsillectomy. However, at post-operative day seven, the diode laser tonsillectomy group had significantly higher pain scores compared with the cold dissection (p = 0.042) and coblation (p = 0.04) tonsillectomy groups.

Both coblation and diode laser tonsillectomy are associated with significantly reduced blood loss and shorter operative times compared with cold dissection tonsillectomy. However, we advocate coblation tonsillectomy because of the lower post-operative pain scores compared with diode laser and cold dissection tonsillectomy.

Viral gene therapy is a promising new treatment modality for head and neck cancer. This paper provides the reader with a review of the relevant literature in this field.

There are government licensed viral gene therapy products currently in use for head and neck cancer, utilised in conjunction with established treatment modalities. The viruses target tumour-associated genes, with the first licensed virus replacing p53 gene function, which is frequently lost in tumourigenesis. Oncolytic viruses selectively destroy cancer cells through viral replication and can be armed with therapeutic transgenes.

Despite considerable advances in this field over the last 40 years, further research is needed to improve the overall efficacy of the viruses and allow their widespread utilisation in the management of head and neck cancer.

This paper presents a series of three patients who were identified as having partial thickness involvement of the laryngotracheal complex secondary to invasive, well-differentiated thyroid cancer. These patients were managed with full thickness window resection and reconstruction using a composite nasal septal graft.

A review of the Princess Alexandra Hospital database (comprising prospectively collated data) was undertaken to identify patients who had undergone full thickness tracheal resection and reconstruction using a composite nasal septal graft; demographic, operative technique and survival outcome data were collated.

Three patients had a composite nasal septal graft performed for reconstruction of full thickness laryngotracheal defects following the excision of well-differentiated thyroid cancer. There were no cases of local recurrence after a minimum of 18 months' follow up.

This paper describes our surgical technique for reconstruction of these defects using a composite nasal septal graft. It also presents data on our three cases to date, in which the technique has been used safely. A discussion of the surgical management of locally invasive, well-differentiated thyroid cancer is provided.

To investigate the effectiveness of benzodiazepine use for subjective tinnitus and to consider this in the context of the concomitant side effects.

A systematic search of several databases using the terms ‘tinnitus’ and ‘benzodiazepines’ was conducted to find clinical trials of benzodiazepines and comparators in tinnitus patients. These studies were then assessed for risk of bias.

Six clinical trials were included. Clonazepam was found to be effective in three studies, but these studies had limitations regarding adequate blinding. The effectiveness of alprazolam was equivocal. Diazepam was not effective in two studies and oxazepam was effective in one study.

Benzodiazepine use for subjective tinnitus does not have a robust evidence base. Clonazepam has the most evidence to support its use and is relatively less likely to lead to abuse because of its longer half-life, but caution is still needed given the other serious side effects.

This study aimed to review the current advances in superior semicircular canal dehiscence syndrome and to ascertain its aetiology, whether dehiscence size correlates with symptoms, signs and investigation results, the best investigations, and its surgical management.

A literature search using the key words ‘superior semicircular canal dehiscence’ was performed using the Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Medline, PsycINFO, British Nursing Index, Cinahl and Health Business Elite databases for the period January 2009 to May 2014. Systematic reviews, meta-analyses, randomised controlled trials, prospective and retrospective case series, case reports, and observational studies were included.

Of the 205 papers identified, 35 were considered relevant.

The aetiology of superior semicircular canal dehiscence syndrome is unclear. Dehiscence size significantly affects the air–bone gap and ocular vestibular evoked myogenic potential thresholds. Computed tomography evaluation has a high false positive rate. The middle cranial fossa approach is the surgical standard for treating this syndrome; however, the transmastoid approach is gaining popularity.

This study aimed to compare the success rate of type I tympanoplasty in active (wet) and inactive (dry) mucosal chronic otitis media.

A prospective study was performed of 35 patients each with dry ear and wet ear undergoing type I tympanoplasty in the Otolaryngology Department, Postgraduate Institute of Medical Education and Research, India. All patients underwent type I tympanoplasty between January 2010 and June 2011 by the post-auricular approach. Samples of the remnant tympanic membrane were sent for histopathological examination.

After a minimum follow up of one year, the success rate was 88.6 per cent for dry ears and 80 per cent for wet ears. Neither the type (p = 0.526) nor the presence (p = 0.324) of discharge influenced the success rate. Histopathological examination of the tympanic membrane margins was performed for 46 patients: of these, 19 showed evidence of vascularity and 27 did not. There was no significant difference in success rate between groups (p = 0.115).

The success rate was not influenced by the presence of ear discharge at the time of surgery, and tympanic membrane vascularity did not influence graft uptake.

To compare anatomical and audiological results using sliced tragal cartilage and temporalis fascia in type I tympanoplasty.

A retrospective review was undertaken of primary tympanoplasties using sliced tragal cartilage and temporalis fascia from May 2005 to January 2008. In total, 223 ears were operated on using sliced tragal cartilage graft and 167 using temporalis fascia. Statistical analysis of the outcome data was performed.

At the two-year and four-year follow ups, successful closure of the tympanic membrane was achieved in 98.20 per cent and 97.75 per cent, respectively, of the cartilage group compared with 87.42 per cent and 82.63 per cent, respectively, of the temporalis fascia group. At the four-year follow up, the average air–bone gap was 7.10 ± 3.01 dB in the cartilage group and 8.05 ± 3.22 dB in the temporalis fascia group.

The overall success rate for primary cartilage tympanoplasty is higher when using sliced cartilage than with temporalis fascia grafting.

To evaluate the total number of Epley manoeuvres required to provide symptomatic relief to patients newly diagnosed with benign paroxysmal positional vertigo.

This retrospective audit assessed every patient referred to the audiology department for investigations of their symptoms over a period of one year. Only patients diagnosed with benign paroxysmal positional vertigo confirmed via a positive Dix–Hallpike test result, with no suggestion of dual pathology, were included.

Seventy patients with a positive Dix–Hallpike test result were identified. The total number of Epley manoeuvres required ranged from one to five. Thirty-three patients (47 per cent) were asymptomatic following one Epley manoeuvre. Eleven patients (16 per cent) needed 2 manoeuvres and 15 patients (21 per cent) required 3 manoeuvres for symptomatic control.

Symptomatic control of benign paroxysmal positional vertigo was obtained following a single Epley manoeuvre for 47 per cent of patients. The majority of patients (84 per cent) experienced symptomatic improvement following three Epley manoeuvres.

Chronic rhinosinusitis is a common, heterogeneous condition. An effective means of mitigating disease in chronic rhinosinusitis patients remains elusive. A variety of causes have been implicated, with the biofilm theory gaining increasing prominence.

This article reviews the literature on the role of biofilms in chronic rhinosinusitis, in terms of pathophysiology and with regard to avenues for future treatment.

A systematic review of case series was performed using databases with independently developed search strategies, including Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane library, and Zetoc, in addition to conference proceedings and a manual search of literature, with the last search conducted on 18 January 2014. The search terms included the following, used in various combinations to maximise the yield of articles identified: ‘biofilms’, ‘chronic rhinosinusitis’, ‘DNase’, ‘extracellular DNA’ and ‘biofilm dispersal’.

The existing evidence lends further support for the role of biofilms (particularly the Staphylococcus aureus phenotype) in more severe, recalcitrant disease and poorer surgical outcomes.

Multimodality treatment, with a shift in paradigm to incorporate anti-biofilm strategies, is likely to form the mainstay of future recalcitrant chronic rhinosinusitis management.

This study aimed to determine the prevalence of hearing impairment in Bangladeshi people of all ages.

A nationally representative cross-sectional survey was carried out in 2013. A total of 4260 subjects (1774 males and 2486 females), with a mean age of 32 years, participated. Hearing impairment was determined by pure tone audiometry and otoacoustic emissions testing.

Disabling hearing loss (greater than 40 dB loss in adults, and greater than 30 dB loss in children younger than 15 years, in their better hearing ears) was present in 9.6 per cent (95 per cent confidence interval, 8.5–10.8 per cent) of the respondents. Hearing loss was more prevalent in socio-economically deprived people and in those older than 60 years. Multiple logistic regression analysis identified age, socio-economic deprivation, family history, impacted ear wax, chronic suppurative otitis media, otitis media with effusion, and otitis externa as the significant predictors of disabling hearing loss.

Deafness prevention should focus mainly on chronic suppurative otitis media, otitis media with effusion, and impacted ear wax prevention, integrated within the primary healthcare system and addressing the equity issue.

Mastoid surgery carried out to treat chronic otitis media can lead to improvement in objective and subjective measures post-operatively. This study investigated the subjective change in quality of life using the Glasgow Benefit Inventory relative to the type of mastoid surgery undertaken.

A retrospective multicentre postal survey of 157 patients who underwent mastoid surgery from 2008 to 2012 was conducted.

Eighty-three questionnaire responses were received from patients who underwent surgery at one of three different hospitals (a response rate of 53 per cent). Fifty-seven per cent of patients had a Glasgow Benefit Inventory score of 0, indicating no change in quality of life post-operatively. Thirty-five per cent scored over 50, indicating significant improvement. The only significant difference found was that women fared worse after surgery than men.

The choice of mastoid surgery technique should be determined by clinical need and surgeon preference. There is no improvement in quality of life for most patients following mastoid surgery.

This project compares access to the anterolateral part of the jugular foramen provided by the lateral microsurgical preauricular and the anterior endoscopic approaches, and defines the important landmarks involved in each approach.

Cadaveric study.

The endoscopic transnasal/transmaxillary transpterygoid corridor provides a less invasive route for selected lesions in the jugular foramen than the traditional open route through the preauricular subtemporal infratemporal fossa approach. However, the anterior endoscopic approach provides a smaller channel to the jugular foramen than the preauricular approach.

The anterior endoscopic approach to the anterolateral part of the jugular foramen is a useful alternative to the lateral microsurgical preauricular approach in carefully selected cases. The vaginal process of the tympanic part of the temporal bone provides a valuable landmark to aid in accessing the jugular foramen in both procedures and can be drilled to open the foramen in the preauricular approach.