In the summer of 2000, a team of medical and affiliated workers visited the South Sinai Desert to assess the medical problems and needs of the Bedouin population. This paper reports on the ENT diseases of this population, and discusses their healthcare needs.

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.

Little has been published about the difficulties encountered during the insertion of osseointegrated implants for the attachment of bone anchored hearing aids (BAHA) and auricular prostheses in children. This study examines this issue in the first 51 children implanted at our centre. During surgery, the most common problem encountered was the presence of thin bone resulting in incomplete insertion of fixtures. Five fixtures had failed to integrate and six fixtures were lost in the long-term, however, only five children required revision surgery. The reason why few patients require revision was due to the judicious insertion of ‘sleeper’ fixtures. At follow-up, seven children required counselling for psychological problems. It is apparent from this study that osseointegrated implants in children are associated with difficulties, re-emphasizing that a paediatric osseointegration programme requires significant investment, and should only be undertaken by institutions that are committed to its success.

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.

To compare the therapeutic efficacy in the management of granular myringitis, 15 patients with chronic granular myringitis were treated with antibiotic ear drops that were used twice to four times a day, and another 15 patients were treated with daily irrigation of the external canal with dilute vinegar solution. All patients treated with dilute vinegar solution had resolution of their original otorrhoea within three weeks, whereas two-thirds of patients recovered within three weeks when treated with antibiotic ear drops. The disadvantages of dilute vinegar therapy were canal irritation with pain and dizziness. When the therapeutic efficacy was compared statistically, a dry ear was attained in the dilute vinegar-treated group at six weeks and six months in the antibiotic ear drop treated group (p<0.01). These results suggest that very low pH therapy using dilute vinegar solution is definitely effective in the management of granular myringitis.

The aim of this study was to analyse the tissue surrounding prematurely extruded ventilation tubes (grommets). Thirty-one ventilation tubes, including 21 Shah and six Shepherd tubes, that had been extruded naturally into the ear canal were examined. After formalin fixation, material adhering to the tubes was retrieved and processed to paraffin wax. Five tubes were processed for scanning electron microscope (SEM) analysis. Sections were stained using histochemical methods for collagen, keratin and keratohyaline. In addition, the presence of collagen (type I and III), keratin, vimentin, fibronectin, tenascin, factor VIII-related antigen, CD31 and CD45 was tested for by immunohistochemistry. Results showed that all specimens consisted of an acellular fibrous material, oriented in concentric rings parallel to the tube surface that was often associated with small collections of CD45+ inflammatory cells. Two specimens contained collagen that was detectable by histochemical and immunohistological methods. Twelve specimens contained identifiable desquamated epithelial cells containing keratin and keratohyaline. Only one specimen stained positively for connective tissue markers (vimentin, fibrous fibronectin, tenascin) or showed the presence of vascular epithelium. SEM revealed adherent clusters or sheets of plate-like structures, consistent with the presence of epithelial squames, on three of the five ventilation tubes examined. It is concluded that tissue retained on extruded grommets consists of orthokeratinitizing epithelium infiltrated by inflammatory cells, a finding that is consistent with the theory that tube extrusion occurs as a result of squamous epithelial proliferation, medial migration, differentiation and desquamation. epithelial cells containing keratin and keratohyaline. Only one specimen stained positively for connective tissue markers (vimentin, fibrous fibronectin, tenascin) or showed the presence of vascular epithelium. SEM revealed adherent clusters or sheets of plate-like structures, consistent with the presence of epithelial squames, on three of the five ventilation tubes examined. It is concluded that issue retained on extruded grommets consists of orthokeratinitizing epithelium infiltrated by inflammatory cells, a finding that is consistent with the theory that tube extrusion occurs as a result of squamos epithelial proliferation, medial migration, differentiation and desquamation.

The Science Citation Index (SCI) was introduced primarily as a method of information retrieval but has also been used an objective measure of the quality of an article. Citation classics have been described as papers that have been cited 100 times or more. The aim of this study was to identify the articles published during the 20th century in otolaryngology-head and neck surgery journals that have achieved classic citation status and to present an analysis of this data. Using a database provided by the Institute of Scientific Information (Philadelphia, PA), an assessment was performed of all articles cited 100 or more times in one of the 28 clinical otolaryngology-head and neck journals indexed by the annual Journal Citation Reports. The data were based on citation counts using the 1900 through 1999 Science Citation Index. Institutions located in 10 different countries produced 80 noteworthy articles. The most-cited paper achieved a citation score of 406 and there were 11 articles cited on more than 200 occasions. All of the articles were published in eight journals. The earliest identified publication was in 1933 and the most recent was published in 1993. Twenty authors were involved in two articles and four authors were associated with three classic citations. This paper confirms that analysing citation classics reveals a partial insight into advances and historical developments in the specialty during the last century.

The civil claim of occupational rhinitis may be difficult to prove on the balance of probabilities and is the responsibility of the claimant. There are two types of occupational rhinitis, an allergic rhinitis or a rhinitis due to irritation. Occupational rhinitis can be likened to occupational asthma. Particular attention must be paid to the relationship to alleged exposure and symptoms. Irritation causes symptoms during exposure that cease afterwards unless clinically obvious damage has occurred. Tobacco smoke and nicotine may also cause symptoms. A full examination, both externally and internally of the nose, mouth and eyes should be undertaken. The presence of squamous metaplasia is important. The validity of a claimant’s symptoms must be checked against the medical records. Details of all occupations, compounds and protection should be noted. Manufacturing data on the compounds should also be obtained. The Health and Safety Executive publish occupational exposure limits for many industrial chemicals. Allergen-specific IgE may be raised when an allergy is considered to cause the occupational rhinitis. Nasal challenge tests have been used in Scandinavia to diagnose allergic occupational rhinitis. The sense of smell should be tested. There are two approaches, detecting threshold or recognition, which is suprathreshold. When present, three degrees of social effect occur: impairment, disability and handicap. The degree depends on the occupation of the individual.

Guillotine tonsillectomy was the widely practised technique of tonsillectomy in the late 19th century as it was considered a quick and reliable method of removing tonsils. It fell into disrepute in the early 20th century. This paper reviews the history of the origin of the tonsillotome and traces the various modifications over the last few centuries. The current practice of guillotine tonsillectomy is examined by means of a postal questionnaire surveyof all UK consultants.

Graves’ disease may occasionally result in significant proptosis that is either cosmetically unacceptable or causes visual loss. This has traditionally been managed surgically by external decompression of the orbital bony skeleton. Trans-nasal endoscopic orbital decompression is emerging as a new minimally-invasive technique, that avoids the need for cutaneous or gingival incisions. Decompression of the medial orbital wall can be performed up to the anterior wall of the sphenoid sinus. This can be combined with resection of the medial and posterior portion of the orbital floor (preserving the infra-orbital nerve). This technique produces decompression which is comparable to external techniques.

We present a series of 10 endoscopic orbital decompressions with an average improvement of 4.4 mm in orbital proptosis. There was an improvement in visual acuity in all patients with visual impairment. Endoscopic orbital decompression is recommended as an alternative to traditional decompression techniques.

Four cases (seven ears) of metastatic tumour of the internal auditory canal were studied. The histopathological findings confirmed that the inner ear invasion of the tumour follows a unique course, as reported in the literature. Relationship between duration of deafness and extent of tumour invasion in the inner ear is discussed. It is suggested that the deafness could occur via neural invasion or compression near the ductus spiralis foraminosus.

Most otolaryngologists treat patients with chondrodermatitis nodularis (CDN) by wedge excision. Although the results of this technique are generally good, it can leave the patient with an asymmetric, deformed ear.

In the dermatological literature, a relatively straightforward technique has been described for the treatment of CDN by smoothing only the underlying cartilage. This is based on the assumption that CDN is caused by pressure necrosis of protuberant cartilage, and thus is primarily not a skin disease. Reports on this technique claim excellent cosmetic results with only a small chance of recurrence.

In the present study we analyse the application of this technique to 34 patients with 37 CDN lesions. All patients were symptom-free with a minimum follow-up of three months according to their medical reports.

Seventeen patients with 19 lesions were interviewed later by telephone. In a mean follow-up of 30.7 months, 34 of these patients remained symptom-free and only one required revision surgery. The authors recommend this safe and simple technique to other physicians who treat patients with CDN.

Acute otitis externa is a common condition that can be extremely painful. When there is considerable canal oedema, packing is necessary to facilitate the passage of medication. The experience at the Royal Victoria Eye and Ear Hospital is that ear wicks generally require removal in two to three days by medical staff and can be labour intensive as they often involve serial removals following re-insertions. Alternatively, medicated ribbon gauze is cheap and can be removed by the patient at home. Ear wick and mediated ribbon gauze were investigated by a prospective randomized trial involving 94 patients.

Fewer out-patient visits were required for the ribbon gauze group (two vs. three, p<0.0001) with considerably less material and labour costs than the wick group. Similar resolution rates were achieved (70 per cent vs. 64 per cent, p = 0.58). Following development of guidelines, theproportion of otitis externa patient reviews in the accident and emergency department declined from 49 per cent to 36 per cent.

Compared with the ear wick, medicated ribbon gauze is a cost-effective method of treating oedematous acute otitis externa.

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.