This article reviews the literature pertaining to bismuth iodoform paraffin paste.

Bismuth iodoform paraffin paste is used in most otolaryngology departments on a daily basis. Questions about its properties are common in postgraduate otolaryngology examinations. This article reviews bismuth iodoform paraffin paste's current and historical usage, constituents, properties, side effects, and radiographic properties, and its alternatives in otological and rhinological practice.

To investigate whether hair cell immunophenotypes can be derived from the central nervous system.

We established in vitro cell cultures from embryonic day 14.5 fetal rat brain tissue, and analysed changes in the immunohistochemical features of these cell cultures following differentiation.

The immature neural progenitors obtained from the fetal mouse central nervous system generated cell immunophenotypes which expressed epitopes of the hair cell marker proteins myosin VIIa and Brn-3c and the supporting cell marker pan-cytokeratin.

Neural progenitors have the potential to differentiate into inner ear hair cell and supporting cell phenotypes, and thus may be a useful material for cell transplantation therapy aiming to replace damaged inner ear hair cells.

This study aimed to evaluate the effect of lengthening the transition duration of selected speech segments upon the perception of those segments in individuals with auditory dys-synchrony.

Thirty individuals with auditory dys-synchrony participated in the study, along with 30 age-matched normal hearing listeners. Eight consonant–vowel syllables were used as auditory stimuli. Two experiments were conducted. Experiment one measured the ‘just noticeable difference’ time: the smallest prolongation of the speech sound transition duration which was noticeable by the subject. In experiment two, speech sounds were modified by lengthening the transition duration by multiples of the just noticeable difference time, and subjects' speech identification scores for the modified speech sounds were assessed.

Subjects with auditory dys-synchrony demonstrated poor processing of temporal auditory information. Lengthening of speech sound transition duration improved these subjects' perception of both the placement and voicing features of the speech syllables used.

These results suggest that innovative speech processing strategies which enhance temporal cues may benefit individuals with auditory dys-synchrony.

To study the prevalence and patterns of contrecoup injury in traumatic temporal bone fracture cases.

A prospective, cohort study was undertaken of all patients with traumatic head injury admitted to a tertiary referral hospital in Malaysia within an 18-month period. High resolution computed tomography scans of the brain and skull base were performed in indicated cases, based on clinical findings and Glasgow coma score. Patients with a one-sided temporal bone fracture were selected and subsequent magnetic resonance imaging performed in all cases. Contrecoup injury incidence, type, severity and outcome were recorded.

Of 1579 head injury cases, 81 (5.1 per cent) met the inclusion criteria and were enrolled in the study. Temporal bone fractures were significantly associated with intracranial injuries (p < 0.001). The incidence of a contrecoup injury in cases with temporal bone fracture was 13.6 per cent. Contrecoup injury was significantly associated with petrous temporal bone fracture (p < 0.01). The commonest contrecoup injury was cerebral contusion, followed by extradural haematoma and subdural haematoma.

Contrecoup injury is not uncommon in cases of temporal bone fracture, and is significantly associated with petrous temporal bone fracture.

Post-auricular incisions are performed for a range of otological procedures. Anecdotally, many patients suffer some numbness of the pinna or post-auricular skin post-operatively, but for most this appears to reduce with time. This study aimed to investigate this phenomenon.

A single centre, questionnaire-based study was undertaken, assessing the presence of numbness beyond eight months post-surgery, its location, how it changed, and its impact on the patient. Patients whose numbness had resolved provided details of any temporary deficit. Data were acquired for 35 primary and 16 revision procedures.

Sixty-nine per cent of patients undergoing primary surgery experienced post-operative numbness. Twenty-six per cent had continued numbness after at least eight months' recovery, but only 3 per cent were constantly aware of the deficit. Of those with an ongoing deficit, 78 per cent felt there had been a reduction in the severity, and 67 per cent in the area size, over time. Recovery appeared to be slightly worse in revision cases.

To explore the protective effects of brain-derived neurotrophic factor on the noise-damaged cochlear spiral ganglion.

Recombinant adenovirus brain-derived neurotrophic factor vector, recombinant adenovirus LacZ and artificial perilymph were prepared. Guinea pigs with audiometric auditory brainstem response thresholds of more than 75 dB SPL, measured seven days after four hours of noise exposure at 135 dB SPL, were divided into three groups. Adenovirus brain-derived neurotrophic factor vector, adenovirus LacZ and perilymph were infused into the cochleae of the three groups, variously. Eight weeks later, the cochleae were stained immunohistochemically and the spiral ganglion cells counted.

The auditory brainstem response threshold recorded before and seven days after noise exposure did not differ significantly between the three groups. However, eight weeks after cochlear perfusion, the group receiving brain-derived neurotrophic factor had a significantly decreased auditory brainstem response threshold and increased spiral ganglion cell count, compared with the adenovirus LacZ and perilymph groups.

When administered via cochlear infusion following noise damage, brain-derived neurotrophic factor appears to improve the auditory threshold, and to have a protective effect on the spiral ganglion cells.

To describe the pattern of ear injuries sustained by all British servicemen serving in Iraq and Afghanistan between 2006 and 2009; to identify all servicemen evacuated to the Royal Centre for Defence Medicine following blast injury; to ascertain how many underwent otological assessment; and to calculate the incidence of hearing loss.

A retrospective analysis of data obtained from the Joint Theatre Trauma Registry and the Defence Analytical and Statistics Agency, together with audiometry records from the University Hospitals Birmingham National Health Service Trust.

Ear damage was present in 5 per cent of all British servicemen sustaining battle injuries. Tympanic membrane rupture occurred in 8 per cent of personnel evacuated with blast injuries. In 2006, 1 per cent of servicemen sustaining blast injury underwent audiography; this figure rose to 13 per cent in 2009. Fifty-three per cent of these audiograms were abnormal.

The incidence of tympanic membrane rupture was higher than that found in previous conflicts. Otological assessment prior to and following military deployment is required to determine the incidence of ear injury amongst British servicemen following blast trauma.

To define the clinical and audiological features of normal-hearing tinnitus patients with spontaneous otoacoustic emissions, and to evaluate the role of spontaneous otoacoustic emissions in tinnitus generation.

Thirty-two patients with spontaneous otoacoustic emissions were compared with 29 patients without spontaneous otoacoustic emissions, regarding clinical and audiological aspects.

The mean age of the study group subjects was significantly lower, and they experienced the kindling effect less frequently than the control group. The mean tinnitus handicap inventory score of the study group was considerably higher than that of the controls, although the difference was not statistically significant. The study group had significantly quieter tinnitus, and higher transient evoked and distortion product otoacoustic emission responses, compared with the control group.

Normal-hearing tinnitus patients with spontaneous otoacoustic emissions have different clinical and audiological characteristics, compared with those without spontaneous otoacoustic emissions. Appropriate evaluation and treatment should be considered at an early stage in these patients.

This study aimed to evaluate the sensitivity of transient evoked otoacoustic emission testing as a screening tool for hearing loss in children, after grommet insertion.

A prospective study was conducted of 48 children (91 ears) aged three to 16 years who had undergone grommet insertion for glue ear. At post-operative review, pure tone audiometry was performed followed by transient evoked otoacoustic emission testing. Outcomes for both tests, in each ear, were compared.

The pure tone audiometry threshold was ≤20 dB in 85 ears (93.4 per cent), 25 dB in two ears (2.2 per cent) and ≥30 dB in four ears (4.4 per cent). Transient evoked otoacoustic emissions were detected in 69 ears (75.8 per cent). The sensitivity of transient evoked otoacoustic emission testing for detecting hearing loss was 100 per cent for ≥30 dB loss but only 66.7 per cent for ≥25 dB loss.

Transient evoked otoacoustic emission testing offers a sensitive means of detecting hearing loss of ≥30 dB following grommet insertion in children. However, the use of such testing as a screening tool may miss some cases of mild hearing loss.

Despite the patient numbers and scope of ENT surgery, it is under-represented in most undergraduate medical curricula.

An online questionnaire was e-mailed, at National Health Service trust level, to 3544 newly qualified doctors from 30 UK medical schools. Undergraduate ENT exposure, confidence and educational value were measured on a Likert scale.

We received 444 eligible responses. The mean undergraduate ENT exposure was 3.4 days of pre-clinical teaching plus 5.0 days of ENT departmental experience. However, 15.8 per cent of respondents reported no formal departmental ENT experience, and 65.8 per cent would have liked further undergraduate experience. Teaching modalities with a lower perceived educational value were generally offered more frequently than those with a higher perceived educational value. Graduates felt significantly less confident with ENT history-taking, examination and management, compared with their cardiology clinical competencies (p < 0.001).

These results highlight the lack of UK ENT undergraduate education, and the significant effect this has on junior doctors’ clinical confidence. In addition, commonly used teaching methods may not be optimally effective.

To investigate the prevalence of mutations in the coding exon of the GJB2 gene in Iranian children with cochlear implants, and to compare the outcomes of auditory perception and speech production in cochlear-implanted children with and without GJB2 mutation.

One hundred and sixty-six prelingually deaf children who had undergone cochlear implantation at the Iranian Cochlear Implant Center, Tehran, were selected from a pool of 428 implanted children. The prevalence of GJB2 gene mutations was assessed using nested polymerase chain reaction and direct sequencing. To enable comparisons, we also identified 36 implanted children with non-GJB2 deafness. Patients' speech perception and speech production were assessed using the Categorization of Auditory Performance and Speech Intelligibility Rating scales.

Thirty-three of 166 probands (19.9 per cent) were found to have GJB2 deafness-causing allele variants and were diagnosed with DFNB1 deafness. Results also indicated a significant improvement in speech perception and production scores in both GJB2 and non-GJB2 patients over time.

Children with GJB2-related deafness benefit from cochlear implantation to the same extent as those with non-GJB2-related deafness.

We believe the currently accepted indications for frontal osteoma surgery are inappropriate. We propose a new osteoma classification system, below, in order to standardise surgical decisions.

Osteomas were classified based on: relationship of tumour mass to sinus size; tumour proximity to the infundibulum, destruction of sinus walls, and complications. Forty-five osteoma cases were thus classified (1971–2007), 29 of which underwent surgery (64.44 per cent).

Three stages were thus derived: I, tumour/air fraction less than one-third, tumour distant from the infundibulum, no sinusitis, and no complications (18 patients (40 per cent)); II, tumour/air fraction one-third to one-half, no infundibular obstruction, no bone destruction, no sinusitis, and no complications (six (13.33 per cent)); and III, tumour/air fraction more than one-half, partial or total infundibular obstruction, sinusitis, bone destruction, and/or complications (21 (46.67 per cent)).

Study findings suggest the following surgical indications: stage I, no surgery required, implement monitoring protocol; stage II, implement monitoring protocol, surgery may be required depending on tumour severity and general patient condition; and stage III, surgery always required. This system provides a method of standardising osteoma surgical decisions.

To present our experience of running a consultant-based otolaryngology emergency care service for more than five years.

In 2003, we developed a system of consultant-based emergency service: consultants spent a week on-call providing a dedicated emergency service, with routine commitments cancelled.

Our new system had advantages over traditional working practices in terms of consultant involvement, trainee education, continuity and efficiency. It also reduced disruption to elective commitments for both consultants and registrars. This system was fundamental to the successful review of all urgent (and in future elective) cases within target periods. Only 31 per cent of new referrals to the consultant emergency clinics required a further appointment. Good teamwork and flexibility in working arrangements have been essential to the success of this service.

Given that health service changes have reduced junior trainee working hours and numbers, and that patients increasingly expect to be treated by trained doctors, our new consultant-based emergency service has merit. Although implementation in other units may differ, we recommend this new service, for the above reasons.

Jervell–Lange-Nielsen syndrome is characterised by congenital deafness and a long QT interval on electrocardiography.

(1) To survey UK national practice regarding electrocardiography screening of deaf children referred to cochlear implant centres, performed to evaluate for prolonged QT interval as recommended by national guidelines, and (2) to review local practice.

Data were collected via a questionnaire sent to all UK cochlear implant centres, and via review of the medical records of a local cochlear implant centre database.

Eight (42 per cent) of the 19 cochlear implant centres surveyed performed electrocardiographic screening. Thirteen cases of long QT syndrome were reported in seven centres, with two related deaths. In our local cochlear implant centre, 14 (7.1 per cent) of 193 children had abnormal electrocardiograms; one definite long QT syndrome case and 13 borderline cases were identified.

Despite clear national guidelines for electrocardiographic screening of deaf children, there is wide variation in practice. Our local practice of performing investigations, including electrocardiography, during magnetic resonance imaging sedation has been very successful. Electrocardiograms should be reviewed by trained clinicians, and corrected QT intervals should be calculated manually.

To investigate the hypothesis of cochlear and retrocochlear damage in scrub typhus, using evoked response audiometry.

Prospective, randomised, case–control study.

The study included 25 patients with scrub typhus and 25 controls with other febrile illnesses not known to cause hearing loss. Controls were age- and sex-matched. All subjects underwent pure tone audiometry and evoked response audiometry before commencing treatment.

Six patients presented with hearing loss, although a total of 23 patients had evidence of symmetrical high frequency loss on pure tone audiometry. Evoked response audiometry found significant prolongation of absolute latencies of wave I, III, V, and wave I–III interpeak latency. Two cases with normal hearing had increased interpeak latencies. These findings constitute level 3b evidence.

Findings were suggestive of retrocochlear pathology in two cases with normal hearing. In other patients, high frequency hearing loss may have led to altered evoked response results. Although scrub typhus appears to cause middle ear cochlear and retrocochlear damage, the presence of such damage could not be fully confirmed by evoked response audiometry.

High sodium salicylate doses can cause reversible hearing loss and tinnitus, possibly due to reduced outer hair cell electromotility. Sodium salicylate is known to alter outer hair cell structure and function. This study determined the reversibility and cochlear recovery time after administration of an ototoxic sodium salicylate dose to guinea pigs with normal cochlear function.

Prospective experimental investigation.

All animals received a single 500 mg sodium salicylate dose, but with different durations of action. Function was evaluated before drug administration and immediately before sacrifice. Cochleae were processed and viewed using scanning electron microscopy.

Changes in outer hair cell function were observed to be present 2 hours after drug administration, with recovery of normal anatomy beginning after 24 hours. Subsequently, derangement and distortion of cilia reduced, with effects predominantly in row three. At 168 hours, cilia were near-normal but with mild distortions which interfered with normal cochlear physiology.

Ciliary changes persisted for up to 168 hours after ototoxic sodium salicylate administration.

The aetiology of tympanosclerosis is not yet clear. This prospective, controlled, clinical study investigated the relationship between Helicobacter pylori and tympanosclerosis aetiology.

The study included 14 patients with tympanosclerosis and 26 with other forms of chronic otitis media. All patients underwent surgery for chronic otitis media. Mucosal biopsies were taken, and examined for H pylori using the Campylobacter-Like Organism (CLO) test.

Tympanoplasty was performed in 29 patients (72.5 per cent), radical mastoidectomy in eight (20 per cent) and myringoplasty in three (7.5 per cent). The presence of H pylori was tested in all tympanosclerosis biopsies, but in only 26.9 per cent of biopsies from other forms of chronic otitis media. A statistically significant difference in H pylori presence was found (p ≤ 0.01).

This study represents a preliminary investigation of the association between H pylori and tympanosclerosis development.

To present the results of primary myringoplasty procedures together with the perforation cause, perforation size and site, surgeon's experience, and surgical method, and to investigate how these factors relate to graft ‘take’ rates.

Retrospective chart review of 243 consecutive patients undergoing primary myringoplasty with temporalis fascia underlay over a 10-year period from 1994 to 2004.

The overall graft take rate was 95 per cent. The retroauricular approach resulted in a 97 per cent graft take rate, whereas a significantly lower rate (77 per cent) was seen for surgery conducted via the endaural approach, or via an ear speculum. There was no relationship between other factors and tympanic membrane healing.

No association was found between perforation cause and graft take rate. The underlay technique is safe and reliable, and the retroauricular approach is preferable as it enables good surgical access and has better results.

To assess the diagnostic utility of using television volume as a marker for hearing loss.

Prospective study using a self-administered questionnaire.

ENT and audiology out-patient departments in the north of England.

One hundred and seventeen patients with a history of hearing loss, undergoing pure tone audiometry for the first time.

sensitivity, specificity, diagnostic accuracy, and positive and negative predictive value of television volume as a marker of hearing loss.

The data indicated that if the patient (or their partner or parent) reported viewing television with an increased volume, then there was a 68 per cent chance of the patient having a hearing loss of 25 dB or more. Patients reporting increased television volume had a mean hearing loss of 35 dB. Increased television volume had a sensitivity of 81 per cent and a specificity of 52 per cent as a predictor of hearing loss. Patients who increased their television volume to watch news programmes had an average hearing loss of 41 dB; increased television volume for news programmes had a sensitivity of 75 per cent and a specificity of 71 per cent as a predictor of hearing loss.

Television volume is a useful marker of hearing loss in situations where audiometry is unavailable, for instance in a primary care setting. However, it is not a very specific test.