This study evaluates the safety and utility of Eustachian tube balloon dilatation in treating Eustachian tube dysfunction symptoms in adults without middle-ear disease.

A prospective cohort study was performed. Adults with dilatory Eustachian tube dysfunction symptoms and no middle-ear disease underwent Eustachian tube balloon dilatation. A clinical assessment including tympanometry, pure tone audiometry, otoscopy, ability to Valsalva, and Eustachian Tube Dysfunction Questionnaire-7 was performed pre-operatively and repeated during a 12-month follow-up period.

Fifteen participants were enrolled. The mean pre-operative Eustachian Tube Dysfunction Questionnaire-7 score of 4.6 reduced to 2.5 at six weeks (P < 0.01), 3.0 at six months (P = 0.02) and 2.6 at 12 months (P < 0.01) post-operatively. All patients without evidence of negative middle-ear pressure had Eustachian Tube Dysfunction Questionnaire-7 score improvements. There were no post-operative complications.

Eustachian tube balloon dilatation is safe and effective at treating Eustachian tube dysfunction in patients with no middle-ear disease or evidence of negative middle-ear pressure.

The aim of this study is to investigate hearing outcomes in patients who have undergone cerebrospinal fluid (CSF) leak repair via a middle cranial fossa (MCF) approach and to identify any variables that influence post-operative hearing outcomes.

This is a multi-centre study. A total of 65 patients who underwent an MCF approach CSF leak repair were included. Retrospective case review was conducted to collect patient demographic and clinical data including pre- and post-operative audiometry.

A total of 65 patients were included: 9 patients (9.2per cent) had an encephalocele confirmed on magnetic resonance (MR) imaging, whilst the remaining patients had biochemically confirmed, beta-trace protein positive CSF leaks. Post-operatively, there was a statistically significant improvement in both bone conduction (Z = -3.71, p < 0.001) and air conduction thresholds (Z = -5.82, p < 0.001). None of the studied variables were found to be associated with the degree of hearing improvement.

The MCF approach for CSF leak repair yields favorable audiological outcomes.

The father of Czech music, Bedřich Smetana was a brilliant, patriotic Romantic composer who spent his last decade completely deaf. He became progressively ill in his final years and passed away prematurely at 60 years old. Since then, there have been two main propositions for the etiology of his neurological symptoms, in particular his hearing loss: neurosyphilis or osteomyelitis of the temporal bone.

This article compares the clinical presentation and pathology of neurosyphilis and osteomyelitis.

This article infers which one is arguably the most likely cause based on Smetana’s own medical history, signs and symptoms and autopsy findings.

Smetana’s clinical presentation and pathological results grant us a clearer picture of his neurological condition and allows us to diagnose his final neurological deterioration as complications of neurosyphilis and not osteomyelitis of the temporal bone.

The association between diagonal earlobe crease and cardiovascular disease has been known for several decades. This review investigated whether there is a significant association between the presence of a diagonal earlobe crease and coronary artery disease independent of other confounding factors.

This study was a systematic review and meta-analysis of selected studies using the Preferred Reporting Items for Systematic Reviews and Meta-analyses checklist.

This study included 12 studies in the pooled analysis with 2415 cases and 2545 controls. The study found that patients with diagonal earlobe crease have an increased (four times) likelihood of having coronary artery disease. In addition, despite some previous studies suggesting that diagonal earlobe crease was simply a result of age, all 10 of the included studies that looked at this found that the relationship between diagonal earlobe crease and coronary artery disease was independent of both age and other known cardiovascular risk factors.

Patients with diagonal earlobe crease appear to have an increased risk of coronary artery disease, and this may be higher for patients with bilateral diagonal earlobe crease.

First bite syndrome refers to pain in the parotid region during the first bite when eating that improves with subsequent bites. There is a paucity of evidence in the literature to justify recommending optimal management therefore this study aimed to review the latest evidence for its management.

A literature search across four databases was conducted using a Population, Intervention, Comparison, Outcome-generated search strategy between 2012 and 2022. Screening was done by two reviewers according to pre-determined inclusion and exclusion criteria, demonstrated in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flowchart.

Eleven articles were included. Six articles used repeated botulinum toxin injection, which in all the studies resulted in complete symptoms resolution. Four articles found a watch-and-wait technique to be effective. There were conflicting results on the efficacy of medical treatments such as opioids or anticonvulsants.

Studies have shown that first bite syndrome symptoms eventually resolve with conservative management, but repeated botulinum toxin appeared efficacious for quicker symptom resolution. Further higher-quality studies should be conducted to identify the optimal management.

A range of chronic ear complaints may be attributed to Eustachian tube dysfunction. Eustachian tube dysfunction secondary to a deviated nasal septum has been described in several clinical studies, with symptomatic improvement demonstrated following septoplasty. However, uncertainty exists as to the size of the effect and consistency between studies.

Electronic searches were carried out of Pubmed, Embase and the Cochrane Library for adult patients with complaints of nasal obstruction and/or impairment and/or complaints of ear fullness undergoing nasal surgery.

Seven studies met the inclusion criteria. Studies evaluated the effect of nasal surgery on Eustachian tube dysfunction using a variety of outcomes, including Eustachian tube function tests, the Eustachian Tube Dysfunction Questionnaire-7, tympanometry and Nasal Obstruction Symptom Evaluation scores. The results demonstrated the positive impact of nasal surgery on various outcomes related to Eustachian tube dysfunction.

Nasal surgery has been demonstrated to have promising results as a therapeutic option for patients with Eustachian tube dysfunction and a deviated nasal septum, offering significant symptom relief and improved quality of life. Through the integration of the treatment of nasal symptoms in the management of Eustachian tube dysfunction, clinicians can adopt a comprehensive approach to addressing the underlying pathologies contributing to Eustachian tube dysfunction.

Drains are used post-parotidectomy to reduce seroma and haematoma formation. Tissue-derived thrombin sealant can enable a drainless procedure, allowing for an earlier discharge, less discomfort and a more cost-efficient method. This study aimed to assess whether tissue sealant improves wound-related outcomes in parotidectomy.

A systematic literature review was performed using a standardised published methodology and custom database search strategy. A fixed-effect meta-analysis of the combined complications was conducted.

Thirteen studies were identified relating to parotidectomy procedures using tissue sealants, of which nine were included in the quantitative synthesis. Our analysis suggested a reduction in the complication rates, including haematoma and seroma, with drainless parotidectomy procedures involving tissue sealant use when compared with conventional procedures with post-operative drain use.

Fibrin sealant in parotidectomy may be used to facilitate a drainless approach, expediting recovery and offering better comfort to patients.

This study aims to assess the pure tone auditory thresholds in infantry and artillery personnel to evaluate potential hearing loss and ascertain the effect of military service duration on these thresholds.

A total of 108 participants, comprising 35 infantry, 30 artillery personnel, and 43 healthy volunteers as controls, underwent conventional and high-frequency pure tone audiometry. Thresholds were measured across frequencies of 125–16000 Hz.

Artillery personnel exhibited significantly higher hearing thresholds compared to controls across various frequencies, particularly in the right ear. Infantry personnel showed elevated thresholds at specific frequencies in the left ear. Correlations were observed among age, years of service and number of shots fired.

Repetitive exposure to firearm noise can lead to significant hearing loss across a broad frequency range. Implementing comprehensive ear protection programs for military personnel is crucial to mitigate these risks.

This study aimed to assess the impact of the scutum on oval window accessibility during stapedotomy surgery. Radio-clinical correlation was applied to determine the impact.

This was a prospective observational case-series study that included 127 candidates for stapedotomy surgery. The oval fossa was classified into two types according to the accessibility of the stapes footplate.

Both study groups showed a statistically significant difference in pre-operative radiological length as the p value was less than 0.001. The Spearman correlation coefficient revealed that the intra-operative oval window fossa was only significantly related to the radiological scutum length because the p value was less than 0.001.

Our results revealed that the pre-operative radiological length can predict the intra-operative oval fossa type with high sensitivity and specificity. Patients with a pre-operative scutum length of less than 2.35 mm were predicted to have an easily accessible oval window without requiring intra-operative scutum curettage.

To assess the face and content validity of artificial temporal bone dissection in surgical training in the UK.

Expert and non-expert groups participated in artificial temporal bone dissection at the Queen Elizabeth Hospital, Birmingham, UK. Face and content validity were assessed by a validated post-dissection questionnaire.

The median content validity score was 34 out of 35 (interquartile range 32.00–35.00). Mean face validity score compared to human was 45.76 out of 65 (95 per cent CI 42.57–48.94). Face validity compared to cadaveric models demonstrated equivalence (95 per cent CI 25.30–30.70, crossing equivalence value 27.00). Experts rated face validity less favourably than non-experts (p = 0.012 and 0.042, respectively). Content validity was equivalent between experts and non-experts (p = 0.052). There were no significant differences in total content (p = 0.606) and face validity (p = 0.133, p = 0.105) scores between different artificial bones.

The high content and face validity suggests ENT training programs should consider formally incorporating artificial models into mastoid surgery training pathways.

For 50 years, the Thomas Wickham-Jones (TWJ) Foundation has promoted the advancement of otology and audiology in the UK and Republic of Ireland through a series of overseas Fellowships and other grants.

The paper examines the history of the Foundation since its establishment in 1974, drawing upon the Foundation's archives and personal recollections. The analysis is located within a framework concerning the factors that shape the success or failure of a foundation including vision, strategy, information, leadership and finance.

The activities of the TWJ Foundation are charted over five decades, and the governance of the Foundation is detailed. Particular attention is given to the Major Fellowships offered, at first in North America, and to their subsequent development into the Foundation's current rotation.

The paper offers an assessment of the TWJ Foundation's impact on the training of otologists in the British Isles and concludes with a brief self-reflective analysis.

To clarify incidence, progression and effect on quality of life of shoulder/neck disability, oral asymmetry, neuropathic pain and numbness following neck dissection.

This prospective telephone-interview study delivered the Neck Dissection Impairment Index, Neuropathic Pain Questionnaire, House–Brackmann Scale and questions assessing numbness to patients before and three times after neck dissection.

Mean Neck Dissection Impairment Index (6.43 vs 22.17; p = 0.004) and Neuropathic Pain Questionnaire scores (0.76 vs 2.30; p = 0.004), proportions of patients with oral asymmetry (3 per cent vs 33.3 per cent; p = 0.016), ear (5.9 per cent vs 46.7 per cent; p = 0.002), jaw (5.9 per cent vs 53.3 per cent; p < 0.001) and neck numbness (5.9 per cent vs 53.3 per cent; p < 0.001) each increased significantly from pre-operation versus 12 weeks after. Neuropathic pain diagnoses did not reach significance. No outcome returned to baseline and progression of each was illustrated over time.

The findings demonstrated that these complications are common and persist throughout short-term recovery. Screening to identify and manage complications could improve post-operative care.

To compare characteristics between stroke populations with and without sensorineural hearing loss (SNHL) and assess the impact of SNHL on stroke outcome.

A retrospective study of patients admitted with stroke was carried out. Patients were divided into two groups, where group A were diagnosed with SNHL and group B were without SNHL. Baseline age, gender, vascular risk factors and disability were compared. Logistic regression analyses were performed with three-month mortality and SNHL as dependent variables.

A total of 631 admissions were reviewed, with mean age 79.2 years, including 305 patients with SNHL and 326 without. More severe disability was more prevalent in patients with SNHL. Sensorineural hearing loss was not associated with increased mortality (odds ratio = 1.1, 95 per cent confidence interval = 0.7–2.0, p = 0.668). Hypertension was present in 210 (68.9 per cent) with SNHL versus 189 (58 per cent) without SNHL (p = 0.005). Small-vessel disease aetiology was more prevalent in SNHL 51 (16.7 per cent) versus 30 (9.2 per cent) without SNHL (p = 0.005).

Sensorineural hearing loss appears to have an association with stroke of small-vessel disease aetiology and hypertension. Sensorineural hearing loss does not affect three-month mortality but is associated with increased disability.

This study aimed to compare the graft success rate, hearing outcomes, operation time and complications between myringoplasty with raising of a mucosal flap (RMF) and raising of a tympanomeatal flap (RTF) for the repair of subtotal perforations.

Subtotal perforations were recruited and randomly allocated to either the RMF group or the RTF group. The graft success rate, hearing outcomes and complications were evaluated at 6 months post-operatively.

The mean operation time was 31.4 ± 2.8 minutes (range: 26–47) in the RMF group and 57.6 ± 0.9 minutes in the RTF group (p < 0.01). The graft success rate was 96.0 per cent in the RMF group and 88.9 per cent in the RTF group (p = 0.659).

Endoscopic myringoplasty with the RMF achieved similar graft success and hearing gain compared to the tympanomeatal flap technique for repairing subtotal perforations, but with significantly shorter operation time and minimal temporary hypogeusia.

Managing benign tumours of the external nose involves balancing optimal excision with the preservation of nasal function and aesthetics. This study aims to identify histologic diagnoses, surgical strategies and post-operative outcomes.

A retrospective cohort study was conducted from November 2006 to March 2023. All surgeries were performed by a single surgeon

The included 24 patients with a mean age of 32.7 ± 19.2 years (range, 3 months to 65 years) at diagnosis. Tumours were predominantly located on the nasal dorsum (n = 11). Among the 11 histologic tumour types, haemangioma was the most common (n = 8). Most patients (70.8 per cent) underwent an open rhinoplasty approach. Recurrence occurred in four patients (16.7 per cent).

Benign tumours of the external nose exhibit diverse pathology. Partial tumour removal may be considered in extensive cases with skin involvement for preserving nasal aesthetics. A tailored surgical strategy is crucial for managing these rare tumours.

The objective of this study was to evaluate graft success, hearing improvement, and complications following perichondrium–cartilage underlay myringoplasty without external auditory canal packing.

In this prospective study, we examined 37 ears of 37 patients with large perforations who underwent endoscopic perichondrium–cartilage underlay myringoplasty without external auditory canal packing. Patients were followed up for six months.

At one week after the surgery, the graft was in situ in 35 (94.6 per cent) ears. At 2–3 weeks post-surgery, among the 35 ears without infection, the graft was in situ in 29 (82.9 per cent) ears, and the graft was bulging in 6 (17.1 per cent) ears. At six months post-surgery, the graft success rate was 94.6 per cent (35 of 37 ears). No graft lateralisation or graft medialisation was encountered during the follow-up period.

The absence of external auditory canal packing did not affect the graft success or hearing improvement following underlay myringoplasty. Thus, external auditory canal packing does not appear to be necessary for underlay myringoplasty.

This research aims to assess the prevalence, severity and underlying causes of hearing impairments.

This cross-sectional study used multistage stratified sampling to select 2148 individuals from Salyan and Surkhet, following the World Health Organization’s Ear and Hearing Survey Handbook.

Among 1946 participants, 38.9 per cent had hearing impairments, including 15.9 per cent with disabling hearing loss, with severity increasing with age. Ear diseases affected 34.3 per cent, including dull or retracted tympanic membranes (18 per cent), impacted wax (8 per cent), perforated tympanic membrane (6.1 per cent), and abnormal tympanometry (23.1 per cent). The major causes were age-related hearing loss (50.5 per cent), Eustachian tube dysfunction (23 per cent), chronic suppurative otitis media (10.8 per cent), and otitis media with effusion (4.7 per cent). Higher education and immunisation were associated with reduced risk, while chronic conditions, earaches, drainage and tinnitus increased the risk.

The high prevalence of hearing impairment, primarily from preventable causes, underscores the importance of early screening and strengthened primary health care.

Despite a lot of scientific advancements in otology, canal wall-down mastoidectomy is still considered to be the standard of care in the management of extensive cholesteatoma. To avoid large cavity related problems, mastoid obliteration has been described in the literature for many decades. Controversy prevails among otologists regarding the materials used for obliteration. This study aimed to evaluate the results of mastoid obliteration and reconstruction of posterior meatal wall after mastoidectomy using ready-to-use, self-setting hydroxyapatite bone cement.

Retrospective analysis was performed of all consecutive patients who underwent canal wall down mastoidectomies and primary mastoid obliteration with ready-to-use, self-setting hydroxyapatite bone cement. Minimum follow-up was 1 year. Primary Outcome measures include need for explantation and post-operative complications.

Total of 26 patients were included in the study. Only one patient required complete explantation. All patients acquired dry cavities in the final follow-up. Few minor complications including external auditory canal granulations and post-aural wound dehiscence. There was no cholesteatoma recidivism.

Ready-to-use, self-setting hydroxyapatite bone cement serves the purpose of mastoid obliteration. In addition, it is time efficient and requires less expertise. It has excellent outcomes in terms of cholesteatoma recidivism. We recommend further research in this area with a large cohort.

This study aimed to evaluate if there is a role for hypoglossal nerve stimulation outside the original Stimulation Therapy for Apnea Reduction (STAR) trial criteria.

This review was conducted using PubMed, Embase and Cochrane Library databases.

Hypoglossal nerve stimulation led to improved outcomes in individuals who fell outside the STAR trial criteria for apnoea-hypopnoea index and body mass index. However, this improvement did not extend to patients with complete concentric palatal collapse or those with a significant central apnoea component.

Hypoglossal nerve stimulation can be effective in patients outside the original STAR trial criteria for certain parameters. Further research is needed to refine patient selection criteria for optimal outcomes.

Necrotising otitis externa is an aggressive infection of the external ear, which extends to the surrounding bone and soft tissue. In recent years, there has been an apparent increase in the number of patients admitted to our hospital with this condition.

A retrospective review was conducted of all patients admitted to our hospital with necrotising otitis externa between July 2012 and June 2020.

Among 39 patients included, only 9 were diagnosed in the first four years, and 30 were diagnosed in the last four years. There were 27 males and 12 females, and the mean age was 78.7 years. There were six non-diabetic immunocompetent patients. Cranial nerve palsies developed in 50 per cent of the patients. Disease-related mortality was 7.7 per cent. A favourable outcome was recorded in 66.7 per cent of the patients.

Necrotising otitis externa is associated with high morbidity and mortality. The incidence of the disease is rising in our local geographical area.