This study aimed to determine whether intratympanically injected methylprednisolone is effective in treating subjective tinnitus refractory to medical treatment.

Prospective, randomised, placebo-controlled, single-blinded study.

Seventy adult patients with subjective tinnitus of cochlear origin were randomly assigned to receive intratympanic injection of either methylprednisolone or saline solution. The treatment protocol comprised three intratympanic injections, one per week for three weeks. Improvement in tinnitus severity was measured by a self-rated tinnitus loudness scale and by the tinnitus severity index, at baseline and two weeks after the last injection.

Data for 59 patients were available for analysis. There was no significant difference between the two treatment groups regarding age, sex, pure tone average, pretreatment tinnitus intensity, tinnitus laterality or tinnitus duration. There was a significant post-treatment improvement in self-rated tinnitus loudness scale results in both groups. No significant post-treatment changes in the tinnitus severity index individual and total scores were observed in either group. The most frequently encountered side effects were pain during injection, vertigo, a burning sensation around the ear and in the throat, and a bitter taste. A burning sensation and bitter taste were observed more often in the methylprednisolone group compared with the placebo group

The results of this study indicate that intratympanic methylprednisolone has no benefit, compared with placebo, for the treatment of subjective tinnitus of cochlear origin refractory to medical treatment.

To compare the procedure, results and complications of conventional septoplasty with those of endoscopic septoplasty, in cases of limited septal deviation and septal spurs.

Prospective study; interventional type; randomised block design; comparative clinical trial.

We included in the study 80 patients presenting with limited septal deviation, septal spur with nasal obstruction, or deviated septum with septal correction was required in order to access the ostio-meatal complex (OMC) for functional endoscopic sinus surgery. Of these 12 were children with septal deviation producing significant nasal obstruction. All patients were divided into two groups- with one undergoing conventional and the other endoscopic septoplasty. Post-operative assessment was carried out one month, three months and one to two years after the procedure.

Post-operative complications such as haemorrhage, infraorbital oedema, nasal pain and in-patient hospital was slightly more in the conventional septoplasty group.

No statistically significant difference was found between the conventional and endoscopic septoplasty groups, as assessed by subjective and objective evaluation.

Although modern endoscopic laser techniques aim to avoid a permanent tracheostomy by augmenting the glottic aperture in cases of bilateral vocal fold palsy, loss of tissue from the posterior glottis risks compromising voice quality and swallowing function. The objective of this study was to describe our experience with bilateral transverse posterior cordotomy.

This was a retrospective analysis of functional outcomes in a series of consecutive patients undergoing a simple modification of the classical laser cordectomy procedure, which avoids tissue loss. The procedure was confined to the complete release of the vocal ligament from the arytenoid cartilage on both sides, while avoiding any significant loss of mucosa or cartilage.

Post-operative voice quality and quality of life were rated as good by most patients, which makes bilateral transverse cordotomy an attractive treatment option for bilateral vocal fold paralysis.

Bilateral transverse cordotomy is a reliable treatment option for patients with bilateral vocal fold paralysis, and aims to avoid the morbidity associated with a permanent tracheostomy.

To establish the prevalence of new vestibular and otological symptoms in a group of patients who had sustained a low grade (Quebec grades one or two) whiplash injury.

A retrospective review of the case records of 109 patients undergoing assessment by a single practitioner for the purposes of compiling a medicolegal report on their whiplash injury.

Four patients complained of short-lived, non-specific dizziness symptoms in the acute phase following their original injury. There were no reports of vertigo, tinnitus or hearing loss after a mean period of 149 days following the whiplash injury.

No patients reported otological or persistent vestibular symptoms in the acute phase following their whiplash injury. This suggests that caution should be exercised when attributing these symptoms to such an injury. Before whiplash injuries are admitted as an aetiological factor in the development of such symptoms, other causes should be excluded.

To describe problems and complications associated with cochlear implantation, and their management, in a Danish patient population comprising both paediatric and adult patients.

Retrospective chart review.

Tertiary referral centre.

Three hundred and thirteen consecutive cochlear implantations were studied. The median age of the study population was 10 years. Sixty per cent of patients were children and 40 per cent were adult; 52 per cent were female and 48 per cent were male.

Two hundred and ninety-four patients received a Cochlear Nucleus® implant. The remaining 19 received an Advanced Bionics implant.

Presence of problems and complications after cochlear implantation.

Post-operative complications were found in 15.7 per cent of patients. The majority of these complications (11.2 per cent) were minor; 4.5 per cent were major. The major complications included one patient with meningitis, one patient with multiple antibiotic resistant Staphylococcus aureus infection of a radical cavity, and one diabetic patient who developed a severe skin infection and whose implant became exposed.

Cochlear implantation is a safe procedure within the studied setting. However, it is essential that careful attention be paid to surgical planning and technique, and it is important that healthcare staff and patients be aware of the possible problems and complications.

To characterise the spectrum of nasal symptomatology and nasendoscopic abnormalities seen in patients attending an asthma clinic, and to relate these symptoms to the likelihood of finding nasendoscopic abnormalities which merit treatment.

Forty-three patients attending a problem asthma clinic were enrolled in an observational study. Cardinal nasal symptoms – obstruction, congestion, hyposmia, rhinorrhoea, sneezing, epistaxis or other symptoms – were graded as none (zero), mild (one), moderate (two) or severe (three), giving a maximum nasal symptom score of 21. Asthma symptoms and lung function were measured. Nasendoscopy was then performed.

Obstruction was the most common cardinal nasal symptom (seen in 15 patients), the median nasal symptom score was 5.3 (range zero to 14) and only three patients had no nasal symptoms. There was no correlation between nasal symptom score and severity of asthma symptoms or forced expiratory volume in one second. Twenty-two patients had a normal appearance on ENT examination (median nasal symptom score four). The nasendoscopic abnormalities seen comprised polyps (n = 8; median nasal symptom score five), deviated nasal septum (n = 7; median nasal symptom score four), oedematous mucosa (n = 4; median nasal symptom score seven) and other abnormalities (n = 2). Individual nasal symptoms were poor predictors of individual nasal pathologies, with hyposmia the best individual predictor of any abnormality (positive predictive value 80 per cent). The presence of a combination of symptoms increased the likelihood of any nasendoscopic abnormality, with obstruction, rhinorrhoea and hyposmia together having a positive predictive value of 100 per cent.

Nasal symptoms are much more frequent than structural abnormalities in patients attending a problem asthma clinic. The threshold for ENT referral should be lower when the patient complains of a symptom complex including hyposmia. Furthermore, concurrent hyposmia, obstruction and rhinorrhoea should be seen as an indication for ENT referral.

To determine the efficacy of inferior turbinate coblation for the treatment of nasal obstruction.

Twenty patients awaiting submucosal diathermy to the inferior turbinates were recruited into the study. All underwent inferior turbinate coblation. Pre-operative and post-operative nasal function was investigated using posterior rhinomanometry and subjective symptom scales.

There was no significant increase in nasal conductance two weeks after inferior turbinate coblation (p = 0.159). However, three months after inferior turbinate coblation, median nasal conductance had increased significantly, from 203 to 324 cm3/s (p = 0.004). The median increase in nasal conductance was 73 cm3/s or 43.5 per cent. Post-operative visual analogue patients' reported post-operative visual analogue scales scores for nasal obstruction decreased significantly, both two weeks (p = 0.006) and three months after inferior turbinate coblation (p = 0.001) when compared to Pre-operative values. There was no change in the reported severity of rhinorrhoea, nasal itching or sneezing. There was a significant relationship (ρ = −0.57, p = 0.014) between pre-operative nasal conductance and change in nasal conductance after inferior turbinate coblation.

This study confirms the short-term efficacy of inferior turbinate coblation for the treatment of nasal obstruction. The benefit was greatest in patients with lower pre-operative nasal conductance. Objective measures of nasal obstruction may be important when selecting patients for inferior turbinate coblation.

The purpose of this study was to determine the economic viability of stapes surgery in Germany. We compared the cost of the operation to the retail value and average cost of a lifelong supply of hearing aids.

Retrospective study.

Tertiary referral centre.

One hundred and sixty-four consecutive cases of primary stapedotomy performed on patients with otosclerosis at our institution served as the representative group for the calculation. The post-operative air–bone gap average at the frequencies 500, 1000, 2000 and 4000 Hz was less than 10 dB for 62 per cent of the patients, and less than 20 dB for 92 per cent of the patients. There was a post-operative sensorineural hearing loss in 1.2 per cent of the patients.

Analysis showed that, even for an elderly patient aged 65 years with a life expectancy of 15 years, the cost of a lifelong supply of hearing aids was greater than that of a stapedotomy procedure. Based on our group of patients, the stapedotomy procedure proved to be €800000 K cheaper than treatment with an averagely priced hearing aid. The economic benefit was still present when taking into account possible revision surgery in 5–10 per cent of cases, and also when, in addition to the surgery, a post-operative hearing aid was required, in for example 20 per cent of cases.

Stapes surgery is economically beneficial for the individual patient as well as for the general patient cohort, irrespective of age. The stapedotomy procedure also prevents the known disadvantages of conventional hearing aids, thus improving the patient's quality of life.

Rhabdomyosarcoma is the commonest malignant tumour of the nose and paranasal sinuses in the paediatric population. Due to its rarity and largely unknown biological behaviour, the treatment of this tumour is complex and controversial. We present the results of multimodality treatment of paediatric sinonasal rhabdomyosarcoma, and we explore the role of surgery in the management of this malignancy.

We retrospectively reviewed the records of 14 patients (median age 7.5 years) with sinonasal rhabdomyosarcoma. Six patients underwent major surgery with post-operative chemoradiation. Eight patients received multi-agent chemotherapy and radiotherapy. The mean follow-up time was 58 months (range seven to 276 months).

The five-year overall survival rates for all patients and for the surgery group were 53.9 and 83.3 per cent, respectively. All patients with alveolar rhabdomyosarcoma had a poor prognosis, with a median survival time of 17 months. Intracranial extension and an age greater than 10 years were also associated with an unfavourable outcome. Non- or partial responders to initial chemoradiation died within a year of diagnosis.

Management of paediatric rhabdomyosarcoma requires a combination of chemotherapy, radiotherapy and surgery. Primary chemoradiotherapy is the established treatment approach for advanced tumours. Early stage tumours with favourable histology can be treated successfully with radical surgery, provided that function and cosmetic appearance are preserved.

To evaluate the results of one-stage surgical repair of the meatal skin defect in patients with long-lasting osteoradionecrosis of the outer ear canal, using a postauricular, inferiorly pedicled skin flap. All patients were also treated with hyperbaric oxygen both pre- and post-operatively.

A prospective study evaluating the results of a one-stage surgical procedure to repair the meatal skin defect in five patients with osteoradionecrosis of the outer ear canal. All patients were treated with hyperbaric oxygen both pre- and post-operatively.

In four of the five patients, intact canal skin was achieved after surgery and hyperbaric oxygen therapy. One patient needed a second operation to cover a small remaining area of bare bone. In one patient, wound healing was unsatisfactory and an area of bare bone remained.

In cases of osteoradionecrosis of the outer ear canal, the skin defect can be repaired with an inferiorly pedicled skin flap. Although not yet scientifically proven, the peri-operative application of hyperbaric oxygen may be of additional value to improve wound healing in areas of compromised tissue.

The aim of this study was to describe the results of treatment in patients with ethmoid sinus carcinoma.

We performed a retrospective study of 34 patients with carcinoma of the ethmoid sinus, and collected the following data: age, sex, employment, tobacco and alcohol consumption, tumour-node-metastasis stage, treatment, and survival.

The mean patient age was 64 years. Seventy-six per cent of patients were men and 24 per cent women. Squamous cell carcinoma was the most frequent histological tumour type (44 per cent). Eleven patients were classified as T2, six as T3, six as T4a and 11 as T4b. Two patients (6 per cent) had nodal metastasis at the time of diagnosis. The anterior skull base was involved in 17 patients (50 per cent) and the anterior orbital contents were affected in seven patients (21 per cent). The five-year actuarial observed survival rate for all patients was 44 per cent.

Combined treatment with surgery and post-operative radiotherapy permitted good local control in patients with ethmoid sinus carcinoma. We do not recommend prophylactic neck treatment for ethmoid sinus carcinoma.

Sinus drainage is impeded by the transition spaces that the anterior paranasal sinuses drain into, not the ostia themselves. Addressing the transition spaces and leaving the ostia intact, using the minimally invasive sinus technique, should reverse chronic rhinosinusitis.

To assess patient benefit following use of the minimally invasive sinus technique for chronic rhinosinusitis.

One hundred and forty-three consecutive patients underwent the minimally invasive sinus technique for chronic rhinosinusitis. Symptoms (i.e. blocked nose, poor sense of smell, rhinorrhoea, post-nasal drip, facial pain and sneezing) were recorded using a visual analogue scale, pre-operatively and at six and 12 weeks post-operatively. Patients were also surveyed using the Glasgow benefit inventory, one and three years post-operatively.

We found a significant reduction in all nasal symptom scores at six and 12 weeks post-operatively, and increased total quality of life scores at one and three years post-operatively (25.2 and 14.8, respectively).

The patient benefits of treatment with the minimally invasive sinus technique compare with the published patient benefits for functional endoscopic sinus surgery.

Functional endoscopic sinus surgery is the mainstay of surgical treatment for chronic sinusitis. Day-case surgery has the advantage over in-patient surgery of being cost-effective and resource sparing. The objectives of this study were to assess our results for day-case functional endoscopic sinus surgery.

This was a retrospective case note review of day-case functional endoscopic sinus surgery procedures performed at Leeds General Infirmary from February 2004 to February 2007. We recorded patients' demographic data, operative details, post-operative course and follow-up results.

A total of 105 day-case functional endoscopic sinus surgery procedures were included in the study. Patients' ages ranged from 16 to 93 years; 44 (41.9 per cent) were female and 61 (58.1 per cent) were male. Of these patients, 39 (37.1 per cent) had chronic sinusitis and the rest (66; 62.8 per cent) had nasal polyposis and sinusitis. Sixty-one patients (58.1 per cent) underwent surgery on the morning operating list, while the rest (44; 41.9 per cent) underwent surgery in the afternoon. Of the 105 patients, 24 (22.8 per cent) had undergone previous nasal surgery. The majority of patients (90/105; 85.7 per cent) were discharged on the same day as surgery. The only complication recorded in this study was bleeding, noted in seven patients (6.7 per cent). At the follow-up appointment, 90/105 (85.7 per cent) patients were satisfied with their post-operative results.

Day-case endoscopic sinus surgery can be performed safely as a day-case procedure. The most important factors for a successful outcome are correct patient selection, in terms of general health and social circumstances, and a dedicated day-case team.

To determine if there is a difference in infection rates between Aboriginal and non-Aboriginal children, following tympanostomy and ventilation tube placement, in the Northern Territory, Australia.

A cohort of 213 patients aged zero to 10 years who had undergone tympanostomy and ventilation tube placement at the Royal Darwin Hospital between 1996 and 2004 were identified. Patients were divided into Aboriginal or non-Aboriginal groups, from their medical record. Factors such as age, sex, dwelling (remote or urban) and season were compared for each group, in order to ascertain if they contributed to infection rates. A retrospective analysis of cases was conducted for the two-year post-operative period.

There was no statistically significant difference in infection rates between the two groups (37 vs 35 per cent). There was no statistically significant difference when comparing the two groups for age, sex, season, or remote vs urban dwelling.

Aboriginal children were not prone to more infections following tympanostomy tube placement when compared with non-Aboriginal children.

To identify measurements that may help intra-operative localisation of the sphenopalatine foramen.

The study used three-dimensional surgical navigation software to study radiological anatomy, in order to define the distances and angulations between identifiable bony landmarks and the sphenopalatine foramen.

The distance from the anterior nasal spine to the sphenopalatine foramen was 59 mm (±4 mm; inter-observer variation = 0.866; intra-observer variation = 0.822). The distance from the piriform aperture to the sphenopalatine foramen was 48 mm (±4 mm; inter-observer variation = 0.828; intra-observer variation = 0.779). The angle of elevation from the nasal floor to the sphenopalatine foramen was 22° (±3°; inter-observer variation = 0.441; intra-observer variation = 0.499).

The sphenopalatine foramen is consistently identifiable on three-dimensional, reconstructed computed tomography scans. Repeatable measurements were obtained. The centre point of the foramen lies 59 mm from the anterior nasal spine at 22° elevation above the plane of the hard palate and 48 mm from the piriform aperture. We discuss how these data could be used to facilitate intra-operative location of the sphenopalatine foramen in difficult cases.

Multiple surgical procedures have been advocated for the management of problematic drooling in neurologically impaired children. Parotid duct ligation is a quick and simple operation conducted via an intra-oral approach and usually performed simultaneously with other procedures. In this study, we aimed to evaluate the effectiveness of parotid duct ligation as a discrete procedure.

All children who underwent bilateral parotid duct ligation as the solitary operative intervention at that time, between February 2003 and September 2006, were included in the study.

Ten children were studied. Surgery was successful in 80 per cent of cases. One patient (10 per cent) had a post-operative wound infection.

Bilateral parotid duct ligation is an effective yet conservative operation for drooling in neurologically impaired children. It requires minimal surgical dissection and has a low morbidity rate. It should be considered as a potential first-line procedure in children who aspirate, and as a further surgical option in anterior droolers or those who continue to drool unacceptably following prior surgical intervention.

The patency and volume of the nasal cavity affect the acoustic characteristics of the voice. The aim of this study was to investigate the effect of a nasal decongestant on nasal volumes and nasalance scores, and to determine the relationship between these measures.

Acoustic rhinometry and nasometry were performed in a group of 21 adult volunteers both prior to and following application of a nasal decongestant. The relationship between changes in nasalance scores and acoustic rhinometric parameters was investigated.

After the application of nasal decongestant, statistically significant increases were observed in nasalance scores and in all of the acoustic rhinometric parameters assessed (i.e. minimal cross-sectional area, three cross-sectional areas, three volumes and total volume). However, no significant correlation was found between the changes in nasalance scores and acoustic rhinometric parameters.

Nasal decongestion causes an increase in nasalance scores and nasal cavity volumes. However, the findings of this study indicate that changes in nasalance scores may result from factors other than nasal cavity volume changes.