One hundred consecutive adult cochlear implant patients, numbered 101 to 200 in an ongoing series, were prospectively monitored and data collected using the same protocol as for the first 100 patients. The study period was 1999 to 2001. The total number of procedures was 122. Changes in practice following the first 100 implants included a standard surgical technique with a smaller incision and lesser flap mobilization, and routine facial nerve monitoring. As far as was practicable, the same commercial type of implant was used. There were 111 (91 per cent) implantation episodes, five (4 per cent) explantation episodes, four (3.3 per cent) reimplantation episodes and two (1.6 per cent) revision procedures. Eighty-nine patients underwent unilateral implantation and 11 underwent bilateral implantation.

Major complications included flap breakdown (1.6 per cent), extrusion of electrode array (0.8 per cent) and device failure (0.8 per cent). The overall major complication rate was 3.2 per cent (4/122). The overall minor complication rate was 18 per cent. In addition, 7.3 per cent experienced transient vertigo and 5.7 per cent experienced local discomfort lasting three days on average with complete resolution. The overall complication rate in the second 100 implant patients was lower than in the first 100. Smaller incision and lesser flap mobilization reduced the minor complication rate.

The purpose of this questionnaire study was to evaluate the existing knowledge of binaural hearing and the attitudes and practices of prescribing bilateral hearing aids amongst otolaryngologists in the United Kingdom. Of the 950 questionnaires sent to the current members of the British Association of Otolaryngologists and Head and Neck Surgeons (BAO-HNS), there were 591 respondents (62 per cent). The true response rate with completed questionnaires was 59 per cent. Eighty-one per cent of the respondents were aware of the importance of binaural hearing and had a positive attitude towards binaural fitting. The practice of bilateral hearing aid prescriptions was found to be poor amongst all grades on the NHS (less than 10 per cent of all hearing aid prescriptions). This practice in the private sector was variable, dependent largely on patient preference and affordability. The practice of binaural prescription was higher for patients in the paediatric age group than amongst adults. Two common indications for hearing aid prescriptions for unilateral deafness were otitis media with effusion in children (23 per cent of respondents) and for tinnitus masking in adults (12 per cent of respondents). Many otolaryngologists believed that there was not enough evidence to support bilateral bone-anchored hearing aid implantation and bilateral cochlear implantation. Ninety-four per cent of the respondents believed that binaural hearing was as important as binocular vision.

Over a 12-year period, the Birmingham implantation otology unit has implanted more than 300 patients with bone-anchored hearing aids (BAHA).

The Entific Medical Systems questionnaire was administered to these patients to evaluate the day to day use of the BAHA, professional needs, after-care, wear and tear concerns and service related issues. Data analysis revealed that most patients used their BAHA for more than eight hours a day (90 per cent of BAHA users) and every day of the week (93 per cent of BAHA users). A high degree of satisfaction was expressed as regards sound amplification, listening to radio or television news, listening to music, speech perception in quiet conditions, during conversation with one person in noisy surroundings and conversation with family at home. Some degree of difficulty was expressed with the use of the BAHA during conversation with two or more people in noisy surroundings. A slow process of perceptual acclimatization was noticed with the majority of the patients. The majority of patients were pleased with the service as regards care of the wound, BAHA nursing clinics, device repairs and other service-related issues.

The Birmingham bone-anchored hearing aid (BAHA) programme has fitted more than 300 patients with unilateral bone-anchored hearing aids since 1988. Some of the patients who benefited well with unilateral aids and who had used bilateral conventional aids previously applied for bilateral amplification. To date, 15 patients have been fitted with bilateral BAHAs. The benefits of bilateral amplification have been compared to unilateral amplification in 11 of these patients. Subjective analysis in the form of validated comprehensive questionnaires was undertaken.

The Glasgow benefit inventory (GBI), which is a subjective patient orientated post-interventional questionnaire developed to evaluate any otorhinolaryngological surgery and therapy was administered. The results revealed that the use of bilateral bone-anchored hearing aids significantly enhanced general well being (patient benefit) and improved the patient’s state of health (quality of life). The Chung and Stephens questionnaire which addresses specific issues related to binaural hearing was used. Our preliminary results are encouraging and are comparable to the experience of the Nijmegen BAHA group.

The Birmingham osseointegration programme began in 1988 and during the following 10 years there were a total of 351 bone-anchored hearing aid (BAHA) implantees. In the summer of 2000, a postal questionnaire study was undertaken to establish the impact of the bone-anchored hearing aid on all aspects of patients’ lives.

We used the Glasgow benefit inventory (GBI), which is a subjective patient orientated post-interventional questionnaire especially developed to evaluate any otorhinolaryngological surgery and therapy. It is maximally sensitive to any change in health status brought about by a specific event: in this case the provision of a BAHA.

A total of 312 bone-anchored hearing aid patients, who had used their aids for a minimum period of six months, were sent GBI questionnaires. Two hundred and twenty-seven questionnaires were returned and utilized in the study. The results revealed that the use of a bone-anchored hearing aid significantly enhanced general well being (patient benefit), improved the patient’s state of health (quality of life) and finally was considered a success by patients and their families.

By spring 2000, a total of 351 patients were implanted in the Birmingham bone-anchored hearing aid (BAHA) programme. This group consisted of 242 adults and 109 children. The aim of this retrospective questionnaire study was to directly assess patient satisfaction with their current bone-anchored hearing aid in comparison with their previous conventional air and/or bone-conduction hearing aids.

The Nijmegen group questionnaire was sent by post to 312 patients who used their BAHA for six months or longer. The questionnaire used was first described by Mylanus et al. (Nijmegen group) in 1998. The total response rate was 72 per cent (227 of 312 patients). The bone-anchored hearing aid was found to be significantly superior to prior conventional hearing aids in all respects.

The Birmingham bone-anchored hearing aid programme began in 1988 and by autumn 2000 a total of 351 patients had been fitted with such an aid. The aim of this study was to assess the effectiveness of hearing rehabilitation with the bone-anchored hearing aid. This was a prospective interview-based questionnaire study carried out in the autumn 2000. A total of 84 adult patients were interviewed. Each patient had worn their BAHA for more than one year.

The questionnaire used during these interviews was the Glasgow hearing aid benefit profile (GHABP) and the Glasgow hearing aid difference profile (GHADP). This was first derived and validated by Gatehouse in 1999. The use of bone-anchored hearing aids was found to reduce the level of disability and handicap and provided the most patient benefit and satisfaction.

The Birmingham bone-anchored hearing aid (BAHA) programme, since its inception in 1988, has fitted more than 300 patients with unilateral bone-anchored hearing aids. Recently, some of the patients who benefited extremely well with unilateral aids applied for bilateral amplification. To date, 15 patients have been fitted with bilateral BAHAs. The benefits of bilateral amplification have been compared to unilateral amplification in 11 of these patients who have used their second BAHA for 12 months or longer. Following a subjective analysis in the form of comprehensive questionnaires, objective testing was undertaken to assess specific issues such as ‘speech recognition in quiet’, ‘speech recognition in noise’ and a modified ‘speech-in-simulated-party-noise’ (Plomp) test.

‘Speech in quiet’ testing revealed a 100 per cent score with both unilateral and bilateral BAHAs. With ‘speech in noise’ all 11 patients scored marginally better with bilateral aids compared to best unilateral responses. The modified Plomp test demonstrated that bilateral BAHAs provided maximum flexibility when the origin of noise cannot be controlled as in day-to-day situations. In this small case series the results are positive and are comparable to the experience of the Nijmegen BAHA group.

Melkersson – Rosenthal syndrome (MRS) is a rare condition characterized by recurrent facial paralysis in addition to various orofacial manifestations. The condition appears to be a granulomatous disorder causing oedema and inflammation of the soft tissues of the face, lips, oral cavity and particularly, the facial nerve. There is general agreement that the symptoms and signs resolve spontaneously, aided perhaps by an empirical course of oral steroids. However, in some patients the condition may be progressive, leading to disfiguring facial synkinesis and increasing residual paralysis. There is anecdotal evidence in the literature to suggest that surgical decompression of the facial nerve in its entire intratemporal course may prevent further attacks of facial paralysis and its sequelae. We present here our experience with surgical decompression of the facial nerve in a 27 – year – old woman with MRS who had sufferent recurrent left – sided facial palsy since the age of four. A review of the literature pertaining to facial nerve decompression for Melkersson – Rosenthal syndrome is presented.

Salivary tissue intraductal papillomas are rare, benign tumours that predominantly affect minor salivary glands. We report a case of an intraductal papilloma arising in the unusual site of the submandibular gland. The tumour was completely excised and recurrence is not expected. A brief review of this histologically distinct lesion is presented.

An unusual case of a desmoplastic fibroma of the temporal bone is presented. Although classified benign, this intraosseous lesion exhibits local aggressiveness and has a high potential for recurrence. This rare condition occurs predominantly in the mandible and in the long bones and is seldom seen in the calvarium. Here we add another case to the previously described eight in the skull and this is the fourth such case reported in the temporal bone. The clinical features, radiology, histopathology and the therapeutic considerations of this lesion in a 72-year-old female are discussed. In addition, a literature review of all the cases affecting the skull bones is presented.

A true lipoma is a rare lesion in the oral cavity. A histologically distinct variant is the spindle-cell variety, which is an innocuous lesion that can simulate a myxoid liposarcoma.

We report a case of intra-oral spindle-cell lipoma in a 42-year-old female and have reviewed the literature pertaining to this unusual histopathological entity. A wareness of the condition is essential for both clinicians and pathologists to avoid any misinterpretation of the benign nature of this condition.

Malignant transformation of respiratory papillomata is not uncommon in the presence of precipitating factors such as tobacco smoking and therapeutic irradiation. Respiratory papilloma changing to carcinoma in the absence of smoking and irradiation is seldom seen, with only about 20 documented cases presented in the literature. Here we report one such case in a 30-year-old male patient.

A case of left pyriform sinus fistula in a 20-year-old male is presented. The surgical management of this uncommon condition is discussed. Its embryological and clinical aspects are reviewed.

The human cadaveric styloid process was used as a homograft material for ossicular chain reconstruction in 41 cases of chronic suppurative otitis media over a five-year period. Although technical success was achieved in about 88.23 per cent of the cases, actual patient benefit was around 70.58 per cent; this is comparable to results obtained with most other homologous graft materials. The problem of breakage while remodelling the bone has also increased the risk of transmitting the AIDS virus and consequently undermines the use of this material.