(1) To compare audiometric parameters in patients with vestibular schwannoma and in those with asymmetric hearing loss from other causes; and (2) to assess proposed screening criteria by comparing published protocols.

Audiometric data from 199 vestibular schwannoma patients and 225 non-tumour patients were compared. Eight screening protocols were tested on these 424 patients.

Vestibular schwannoma and non-tumour patients with little or no hearing loss in the unaffected ear were inseparable; however, vestibular schwannoma patients with hearing loss in the unaffected ear had greater audiometric asymmetry, compared with non-tumour patients with the same pattern of hearing loss. The sensitivity of screening protocols varied from 73 to 100 per cent; parallelism was observed between sensitivity and screening rate.

As regards vestibular schwannoma screening protocols, the best compromise between sensitivity and screening rate was offered by a criterion comprising either: (1) ≥20 dB asymmetry at two neighbouring frequencies, or unilateral tinnitus, or (2) ≥15 dB asymmetry at two frequencies between 2 and 8 kHz.

Bacterial biofilm formation has been implicated in the high incidence of persistent otorrhoea after tympanostomy tube insertion. It has been suggested that the tube material may be an important factor in the persistence of such otorrhoea. Development of methicillin-resistant Staphylococcus aureus otorrhoea after tympanostomy tube placement is a growing concern. We evaluated the effect of using vancomycin and chitosan coated tympanostomy tubes on the incidence of methicillin-resistant Staphylococcus aureus biofilm formation in vitro.

Three sets each of vancomycin-coated silicone tubes (n = 5), commercial silver oxide coated silicone tubes (n = 5) and uncoated tympanostomy tubes (as controls; n = 5) were compared as regards resistance to methicillin-resistant Staphylococcus aureus biofilm formation after in vitro incubation.

Scanning electron microscopy showed that the surfaces of the silver oxide coated tubes supported the formation of thick biofilms with crusts, comparable to the appearance of the uncoated tubes. In contrast, the surface of the vancomycin-coated tympanostomy tubes was virtually devoid of methicillin-resistant Staphylococcus aureus biofilm.

Vancomycin-coated tympanostomy tubes resist methicillin-resistant Staphylococcus aureus biofilm formation. Pending further study, such tubes show promise in assisting the control of methicillin-resistant Staphylococcus aureus biofilm formation.

Surgery for vestibular schwannoma may reduce patients' quality of life, but the effect of hearing preservation on this process is not fully understood. Our aim was to determine whether hearing preservation makes a difference to patients' quality of life in this clinical setting.

Retrospective questionnaire and cross-sectional survey.

The study included 104 consecutive patients who had undergone surgery for vestibular schwannoma between 1998 and 2004. Surgery was via a middle cranial fossa route in 24 patients and a translabyrinthine route in 79. Quality of life was assessed using the SF-36 questionnaire and the Glasgow Benefit Inventory.

Quality of life was reduced in both patient groups, with a mean Glasgow Benefit Inventory score of −7.5 (confidence interval (CI) −13 to −2.5) in the translabyrinthine patients and −4 (confidence interval −13.5 to 5.5) in the middle fossa patients. The SF-36 scores did not show any statistically significant difference between the two groups, except for social function (p = 0.01).

Surgery for vestibular schwannoma reduces patients' quality of life, and the preservation of hearing, achieved by using a middle fossa surgical approach, does not significantly alter this result.

Dizziness is prevalent among the elderly. However, little is known about its impact on quality of life and disability, especially in developing countries, where the number of elderly people is increasing.

This study aimed to determine the prevalence of disability, and the quality of life, among elderly persons with dizziness living in the community.

Longitudinal cohort study of dizziness among elderly persons (i.e. aged 65 years and over) residing in Yoruba-speaking areas of Nigeria.

Face-to-face interviews with respondents selected using a multi-stage, stratified area probability sampling of households. Dizziness was based on self-reporting and health-related quality of life was measured using the brief version of the World Health Organization quality of life assessment.

Dizziness was reported and confirmed in 318/1281 elderly respondents, a prevalence of 24.8 per cent. Respondents comprised 197 (61.9 per cent) women and 121 (38.1 per cent) men. Thirty-nine respondents (12.3 per cent) were aged 65–69 years, 91 (28.6 per cent) 70–74 years, 66 (20.8 per cent) 75–79 years and 122 (38.4 per cent) ≥80 years. The prevalence of disability in activities of daily living was 29.56 per cent, and that of disability in instrumental activities of daily living 10.1 per cent. The influence of gender was not significant. The prevalence of disability in activities of daily living (p = 0.00) and in instrumental activities of daily living (p = 0.00) increased significantly with age. Univariate analysis revealed that disability in activities of daily living (p = 0.00), disability in instrumental activities of daily living (p = 0.01), poor family interaction (p = 0.00), poor community involvement (p = 0.00), overall poor health (p = 0.00), current depression (p = 0.01), and difficulty with sedentary (p = 0.00) and vigorous (p = 0.00) activities were significantly more common among elderly respondents with dizziness, compared with non-dizzy elderly respondents. In contrast, cognitive impairment (p = 0.05) was not significantly correlated. The probabilities of the occurrence of difficulty with vigorous or sedentary mobility in our elderly respondents were 2.6 and 1.9, respectively, compared with non-dizzy elderly respondents. Similarly, the probabilities of the occurrence of disability in activities of daily living, current depression and dementia were 1.6 each. Logistic regression analyses for age, sex, medical conditions and presence of disability confirmed that dizziness was significantly associated with worsened cognition. Similarly, dizziness was significantly associated with reduced total quality of life (p = 0.00), and also with reductions in the physical (p = 0.00), psychological (p = 0.00) and environmental (p = 0.00) domains of the research instrument.

Among elderly people with dizziness, there was a high prevalence of significant disability requiring assistance. In addition, dizziness alone significantly reduced these individual's overall total quality of life, and their quality of life as regards physical, psychological and environmental parameters. This information will assist policy planning for the elderly.

This study aimed to investigate antimicrobial treatment of an infected cochlear implant, undertaken in an attempt to salvage the infected device.

We used the broth microdilution method to assess the susceptibility of meticillin-sensitive Staphylococcus aureus isolate, cultured from an infected cochlear implant, to common antimicrobial agents as well as to novel agents such as tea tree oil. To better simulate in vivo conditions, where bacteria grow as microcolonies encased in glycocalyx, the bactericidal activity of selected antimicrobial agents against the isolate growing in biofilm were also compared.

When grown planktonically, the S aureus isolate was susceptible to 17 of the 18 antimicrobials tested. However, when grown in biofilm, it was resistant to all conventional antimicrobials. In contrast, 5 per cent tea tree oil completely eradicated the biofilm following exposure for 1 hour.

Treatment of infected cochlear implants with novel agents such as tea tree oil could significantly improve salvage outcome.

Meningitis is the commonest intracranial complication of suppurative otitis media, and carries the risk of death and life-changing morbidity. This study aimed to estimate the risk of an adult in the UK developing otogenic meningitis.

Adults hospitalised with meningitis in Bristol from 1997 to 2002 were identified retrospectively. Cases confirmed by positive blood culture or cerebrospinal fluid investigation were studied. A case was classified as otogenic if there was coexistent evidence of ear infection.

Eighty-seven cases of meningitis were analysed. The overall mortality rate was 5.7 per cent. Acute and chronic suppurative otitis media accounted for 13 and three cases, respectively. The adult population of Bristol at the midpoint of the study was 635 976.

In this study, the age-adjusted incidence of otogenic meningitis was 0.42 per 100 000 per year.

To evaluate distortion product otoacoustic emissions following stapes surgery in patients with otosclerosis, and to compare in this respect two surgical techniques used in our department.

This retrospective study included 17 stapedectomy and 23 stapedotomy patients aged 16–68 years who had been followed up for at least 12 months. Distortion product otoacoustic emission results at 2, 3, 4 and 5 kHz (i.e. =f2, with 2f1 − f2 = 0.6f2) were obtained pre-operatively and four weeks post-operatively. The control group included 13 volunteers aged 18–50 years with normal hearing and normal otoscopic findings.

Distortion product otoacoustic emissions were detected pre-operatively in 34.8 per cent of stapedotomy patients and 29.4 per cent of stapedectomy patients, and post-operatively in 91.3 per cent of stapedotomy patients and 88.2 per cent of stapedectomy patients. The differences between the stapedotomy and stapedectomy groups were statistically insignificant for each tested frequency, both pre- and post-operatively. The patients' post-operative distortion product otoacoustic emission amplitudes were less than those of normal hearing individuals, even in patients with complete air–bone gap closure and a significant improvement in hearing.

Distortion product otoacoustic emissions were detected in most of our patients following successful stapes surgery, and appeared to be unaffected by the surgical technique or prosthesis used.

To explore the feasibility of a novel surgical management technique for severe, chronic granular myringitis with diffuse granulation tissue over the tympanic membrane, with or without involvement of the external auditory canal.

This was a retrospective design.

A surgical technique combining tympanic epithelial avulsion with overlay myringoplasty was used to treat 21 severe cases.

All 21 cases were cured after one operation. Three months after surgery, patients' tympanic membranes had returned to normal, and their air–bone gaps were less than 10 dB.

This new surgical procedure represents improved treatment for severe, chronic granular myringitis.

To formulate a management plan for spontaneous tonsillar bleeding.

A Medline search was performed and all literature reviewed.

Seventeen publications were identified worldwide, describing 55 cases of spontaneous tonsillar bleeding.

Although spontaneous tonsillar bleeding is a rare presentation, it is documented in the literature. Reported cases indicate an increased incidence in young patients, associated with a higher mortality rate. We propose a management plan for this potentially fatal condition.

In the light of current concerns regarding ciprofloxacin resistance and the changing face of malignant otitis externa, we reviewed cases of malignant otitis externa treated in our centre, in order both to evaluate the current epidemiology of the condition and to assess the status of drug resistance in our patient population.

Retrospective case review of all malignant otitis externa cases managed in a tertiary referral centre in the north-east of England between 2000 and 2009.

Forty-one patients were identified, but the required data were available for only 37 cases. Patients' ages ranged from 51 to 101 years (median, 81 years). Diabetes was present in 51 per cent of patients (19/37), facial nerve palsy in 40 per cent (15/37) and multiple cranial nerve palsy in 24 per cent (9/37). Pseudomonas aeruginosa was the most commonly isolated organism (54 per cent), sensitive to ciprofloxacin in all cases.

The incidence of cranial nerve palsy in our study was higher than in previous reports. The incidence of diabetes and Pseudomonas aeruginosa in our cohort was much lower than previously reported. The Pseudomonas aeruginosa strains isolated were all sensitive to ciprofloxacin, despite recent reports on emerging resistance.

Impaired cochlear perfusion appears to be the most important event in the development of sudden sensorineural hearing loss. Methylenetetrahydrofolate reductase gene mutations at nucleotide 677 cause reduced methylenetetrahydrofolate reductase enzyme activity, resulting in vascular impairment.

Thirty-three patients and 68 control subjects underwent audiological and haematological investigation.

No statistically significant association was found between sudden sensorineural hearing loss and the methylenetetrahydrofolate reductase C677T gene mutation. Mean homocysteine and cholesterol concentrations were significantly higher in patients than in controls. Mean folate levels were significantly lower in patients than in controls. Amongst patients with sudden sensorineural hearing loss, no significant differences in mean cholesterol, homocysteine or folate concentration were found, comparing patients with methylenetetrahydrofolate reductase C677T mutation genotypes with those without.

No statistically significant association was found between the methylenetetrahydrofolate reductase C677T gene mutation and sudden sensorineural hearing loss. There was a statistically significant difference between the homocysteine, folate and cholesterol concentrations of sudden sensorineural hearing loss patients, compared with controls. However, there was no statistically significant difference in these levels, comparing patients with and without the methylenetetrahydrofolate reductase C677T mutation.

Bone-anchored hearing aid implantations have been performed in Manchester for over 20 years. This study examined a range of variables that can occur during the implantation process, and the effect they may have on successful outcome.

Retrospective study and literature review.

Tertiary referral centre in central Manchester.

Details of 602 bone-anchored hearing aid implantation procedures were retrieved from the departmental database. The overall complication rate was 23.9 per cent. The rate of revision surgery was 12.1 per cent.

This study involved a significantly larger number of patients than any previously reported, similar study. Possible reasons for differences in outcomes, and recommendations for best practice, are discussed.

To study the changes in facial nerve function, morphology and neurotrophic factor 3 expression in response to three types of nerve injury.

Changes in facial nerve function (in terms of blink reflex, vibrissae movement and position of nasal tip) were assessed in 45 rats in response to three types of nerve injury: partial section of the extratemporal segment (group one); partial section of the facial canal segment (group two); and complete transection of the facial canal segment (group three). All facial nerves were then dissected out from the sacrificed animals, on the first, seventh or 21st post-operative day, and the injured segment bisected for subsequent analysis. Morphological change and neurotrophic factor 3 expression in these facial nerve segments were evaluated by means of improved trichrome staining and immunohistochemical analysis, respectively.

Facial nerve function was more severely damaged and recovery was slower in group two compared with group one, although the facial nerve injury had been identical at the two sites involved. In group three (complete facial canal transection), scattered degenerative fibres were observed at the transection site on the seventh post-operative day. The number of degenerated fibres, assessed on the seventh post-operative day, was markedly increased in group two compared with group one. On the seventh post-operative day, axonal expression of neurotrophic factor 3 was strongly positive, whereas expression in Schwann cells was only weakly positive.

The facial palsy of the group two rats was more severe than that of group one rats, although their facial nerve function had partly recovered on the 21st post-operative day. Fibre degeneration was not only dispersed throughout the injury site but also occurred throughout the length of the nerve. Neurotrophic factor 3 immunoreactivity increased in facial nerve fibres after partial transection.

To study the outcome of patients with sinonasal teratocarcinosarcoma treated at a single institution.

We reviewed the medical records of 22 patients with histopathologically proven sinonasal teratocarcinosarcoma diagnosed during the period 1993–2007. Treatment was completed in 16 patients.

Fourteen patients underwent surgery (six received craniofacial resection, four open surgery and four endoscopic resection); this was followed by radiation therapy with or without chemotherapy in 11 patients. Two patients received chemoradiation as the definitive treatment. At median follow up in surviving patients of 34 months (range one to 180 months), only five were controlled. Disease recurred in 11 patients, with a median time to recurrence of seven months. The two-year disease-free survival rate and the overall survival rate were 28 and 46 per cent, respectively.

Sinonasal teratocarcinosarcoma appears to be an aggressive disease, with the majority of patients suffering locoregional failure. Multimodality treatment, in the form of a combination of surgery, radiation therapy and chemotherapy, appears to be the optimal approach.

To evaluate the natural course of recurrent vestibulopathy.

Retrospective analysis.

One hundred and five adult patients with attacks of vertigo without auditory or neurological symptoms.

A structured interview was conducted over the telephone, 12 to 62 months after the patient's first visit to the out-patient department.

Two-thirds of patients experienced spontaneous resolution of vertigo, while one-third continued to have symptoms. The diagnosis was subsequently changed to migraine in 2 per cent of patients and to Ménière's disease in 1 per cent.

The prognosis for patients with recurrent vestibulopathy is good. In a few cases, the diagnosis is provisional and will be subsequently changed to migraine or Ménière's disease.

In September 2007, the Department of Health published Uniforms and Workwear: an Evidence Base for Guiding Local Policy. Following this, most National Health Service trusts imposed a ‘bare below the elbow’ dress code policy, with clinical staff asked to remove ties, wristwatches and hand jewellery and to wear short-sleeved tops. There is currently no evidence linking dress code to the transmission of hospital-acquired infection. We designed the current survey to assess patients' perceptions of doctors' appearance, with specific reference to the ‘bare below the elbow’ policy.

A questionnaire showing photographs of a doctor in three different types of attire (‘scrubs’, formal attire and ‘bare below the elbow’) were used to gather responses from 80 in-patients and 80 out-patients in the ENT department. Patients were asked which outfit they felt was the most hygienic, the most professional and the easiest identification of the person as a doctor. They were also asked to indicate their overall preference.

Formal attire was considered most professional and the easiest identification that the person was a doctor. Scrubs were considered most hygienic. Respondents' overall preference was divided between scrubs and formal clothes. ‘Bare below the elbow’ attire received the lowest votes in all categories.

This finding raises significant questions about the Department of Health policy in question. The authors suggest that an alternative policy should be considered, with scrubs worn for in-patient situations and formal attire during out-patient encounters.

To determine the degree of association, if any, between benign paroxysmal positional vertigo and osteoporosis, both of which are disorders of impaired calcium carbonate homeostasis.

A retrospective chart review was undertaken in two otology clinics to assess the prevalence of treated osteoporosis in 260 women with and without benign paroxysmal positional vertigo, between the ages of 51 and 80 years.

There was a statistically significant, negative association between benign paroxysmal positional vertigo and treated osteoporosis in women aged 51 to 60 years. We also observed a trend towards a negative association for women in their 60s, and for the group as a whole.

Osteoporosis, or the medication used to treat it, may provide protection against benign paroxysmal positional vertigo.

To evaluate patient satisfaction and symptom improvement following treatment of Ménière's disease with the Meniett® device.

Retrospective, questionnaire-based audit and analysis of unilateral Ménière's disease patients’ records, following on from a previous study from our departments on intra-tympanic gentamicin for Ménière's disease, using the Vertigo Symptom Scale and Glasgow Benefit Inventory as outcome measures.

Of 33 consecutive patients treated with the Meniett® device for four to six weeks, 30 responded to the questionnaires (90.9 per cent). Respondents’ mean Vertigo Symptom Scale score was 0.7 (range 0–2.1), and their mean Glasgow Benefit Inventory general subscale score was 24.1. Nineteen (63.3 per cent) patients felt that the device had alleviated their vertigo and tinnitus.

This is the first UK study of the effectiveness of the Meniett® device in treating Ménière's disease. It shows that the Meniett® device is a well tolerated, useful and minimally invasive means of treating Ménière's disease after medical treatment has failed, and before more potentially cochleo- and vestibulo-toxic therapies and invasive procedures are utilised.

Upon direct inspection of surgically removed ossicles from the ears of patients with long-term post-mastoidectomy cavity problems, the extent of malleus destruction often appears greater in patients with a longer duration of cavity problems, whereas the extent of incus destruction does not appear to correlate with the duration of cavity problems. This study aimed to investigate this impression.

As a result of total middle-ear reconstruction, 41 ossicles (21 malleus and 20 incus bones) were obtained from 31 patients with post-mastoidectomy cavity problems. The ossicles were examined histopathologically, and the proportion of lamellar bone area to total bone area (expressed as percentage lamellar bone) was measured. We also calculated the inter-operation time, i.e. the time period between the previous mastoidectomy and the recent total middle-ear reconstruction; this parameter was used as an approximate measure of the duration of the patient's cavity problem. Correlations between percentage lamellar bone and inter-operation time were calculated for the two ossicles.

The range of inter-operation times was seven to 65 years. We observed a correlation between percentage lamellar bone and inter-operation time for malleus bones (r = −0.512, p < 0.05), but not for incus bones.

These results were in agreement with our pre-study impressions.

Exposure to cisplatin leads to cochlear cell death by apoptosis; these changes are most marked on the seventh day after exposure. Heat shock proteins are induced in inner ear cells in response to a variety of stimuli. This study examined the role of heat shock protein 70 in cisplatin-induced cochlear cell death.

Fifty-six Sprague–Dawley rats were involved. Some were injected with cisplatin (5 mg/kg body weight), some with cisplatin plus the caspase inhibitor Z-Asp(OMe)-Glu(OMe)-Val-Asp(OME)-fluoromethylketone (5 mg/kg body weight) and others were left as controls (being injected only with saline). Seven days later, we examined the expression of heat shock protein 70 and several other apoptosis-related proteins within the rat cochlear cells; we also assessed total superoxide dismutase activity, auditory brainstem response and auditory steady state response.

Seven days after cisplatin injection, significantly increased expression of heat shock protein 70 was found within the rat cochleae. This correlated with increased executioner caspase levels, total superoxide dismutase activity and auditory brainstem response thresholds, and a significant elevation in auditory steady state response thresholds. Inhibition of caspase-3 activity significantly reduced cochlear heat shock protein 70 expression and total superoxide dismutase activity, and improved auditory brainstem response and auditory steady state response thresholds.

Seven days after cisplatin exposure, we found disturbances of the cochlear cellular machinery involving heat shock protein 70, other apoptotic proteins and total superoxide dismutase.