Ear candles are hollow tubes coated in wax which are inserted into patients’ ears and then lit at the far end. The procedure is used as a complementary therapy for a wide range of conditions. A critical assessment of the evidence shows that its mode of action is implausible and demonstrably wrong. There are no data to suggest that it is effective for any condition. Furthermore, ear candles havebeen associated with ear injuries. The inescapable conclusion is that ear candles do more harm than good. Their use should be discouraged.

Patients with chronic otitis media (COM) may have profound sensorineural hearing loss either due to the disease process or secondary to a surgical procedure. Some patients who are candidates for cochlear implantation may have COM coincidentally. The patients in this group need special attention when cochlear implantation is applied. The aim of this study is to evaluate the potential risks and complications in patients with COM.

Cochlear implantation was performed in six patients with COM or an infected radical cavity and profound hearing loss. Five of them underwent a two-stage operation, and one had a single-stage operation. Cochlear implantation was performed in all patients without complications. The follow-up period was uneventful.

Although such patients have some potential risks, when certain surgical rules are followed very strictly cochlear implantation can be successfully performed in patients with COM.

35delG is the most common mutation in the Connexin-26 gene, representing a major cause of autosomal recessive hearing loss. The aim of this study was to evaluate the relationship between the audiological phenotype and the 35delG mutation in 64 Sicilians with non-syndromic deafness. Pure-tone audiometry and a screening for 35delG mutation were performed. Audiograms were evaluated according to the classification of Liu and Xu. Thirteen homozygotes and nine heterozygotes for the investigated mutation were found. Symmetrical hearing loss was significantly (p=0.008) more common in homozygous subjects than in those without the Connexin-26 mutation. Profound-severe hypoacusia was found in 92.3 per cent of 35delG homozygous, 22.3 per cent of heterozygous and 58.7 per cent of 35delG absent patients. Residual shape audiograms were more frequent in homozygotes. A molecular analysis for the 35delG mutation should be performed in cases of symmetric, severe-profound congenital hearing loss, as a genetic cause is probable in such cases.

This retrospective observational study aimed to establish the outcome for patients packed with a nasal tampon as first-line therapy for epistaxis in Accident & Emergency compared to those packed by ENT. During our study period, 189 admissions were treated with a nasal tampon as first-line therapy; 89 were inserted by ENT and 100 by A&E. A significantly higher number of patients packed by A&E required further treatment to control bleeding (p = 0.004; 95 per cent CI 7–34) than those in the group packed by ENT. A significantly greater proportion from the A&E group required additional cautery alone to control bleeding (p = 0.005; 95 per cent CI 5–30). We suggest that this may be due to inadequate initial assessment and inappropriate first-line therapy in the A&E department. It is recommended that ENT review patients prior to packing, in order to reduce the morbidity associated with multiple treatments.

This study evaluates the outcome and surgical stress associated with surgery for intractable aspiration. A retrospective review was conducted to compare the results between tracheoesophageal diversion and total laryngectomy. The operative time, intra-operative bleeding, time until drain removal, feeding conditions and surgical complications were compared between the two groups. Of the 19 patients, 31.6 per cent underwent tracheoesophageal diversion and 68.4 per cent received total laryngectomy. The operative time and drain insertion periods were statistically shorter in the tracheoesophageal diversion group, while the amount of intra-operative blood loss was smaller in the tracheoesophageal diversion group. The complication rate and the feeding conditions before and after surgery for the two groups did not show anystatistically significant difference. Tracheoesophageal diversion was thus found to be a simple, safe, and reliable therapeutic modality for the control of intractable aspiration. Moreover, it induced less surgical stress than total laryngectomy.

Congenital sinuses arising from the pyriform fossae are rare. They may present as neck cysts, recurrent neck abscesses, thyroiditis or neonatal stridor. Children typically undergo multiple surgical procedures before the diagnosis is made.

We present our recent experience of five third-pouch sinuses and four fourth-pouch sinuses, including one bilateral case. The median age at presentation was four years. The mean number of operations prior to diagnosis was six (range 0-13), with a mean delay to diagnosis of six years. The diagnosis was made by barium swallow, by ultrasound, at pharyngoscopy or at open surgery. The median age at definitive surgery was 10 years. Definitive treatment involved complete excision of the sinus and neck mass in seven cases. Two sinuses were treated with endoscopicdiathermy to their internal opening.

Adoption of the correct nomenclature, diagnostic tools and operative requirements for these cases will help reduce the significant morbidity.

Otolaryngological manifestations of acid reflux include a wide range of pharyngeal and laryngeal symptoms; and the constellation of symptoms has been called laryngopharyngeal reflux.

This is a prospective study in a cohort of patients with various throat symptoms suggestive of laryngopharyngeal reflux (LPR) who underwent flexible oesophago-gastroscopy, as a principal investigation. The aims were to look at the most reliable symptom(s) and sign(s), the diagnostic role of flexible oesophago-gastroscopy and the treatment response in these patients.

The endoscopy score of 0 to 3 was based on endoscopic findings and the treatment response was measured from 0 to 100 per cent improvement of symptoms, as described by the patients.

There were a total of 303 patients, 174 females and 129 males with ages ranging from 19 to 88 years. Seventy-five per cent had had symptoms for more than a year. Fifteen per cent were smokers. Globus, voice change, sore throat, dysphagia and cough were the predominant symptoms. Most patients, however, presented with a complex of various other secondary symptoms.

The endoscopic findings were abnormal in 98 per cent of patients. Apart from the finding of non-specific hyperaemia, usually of the posterior larynx (13 per cent), lesions of the larynx and vocal folds were surprisingly uncommon.

Proton pump inhibitors (PPI) were prescribed in 90 per cent of patients. A total of 233 (76.8 per cent) responded to treatment. The improvement of symptoms ranged from 25 per cent in 36 (23 per cent), 50 per cent in 60 (20 per cent), 75 per cent in 59 (19 per cent) and 100 per centin 78 (26 per cent) patients.

Accumulative analysis of variance showed a significant difference between treatment responders and non-responders (p <0.04). In a logistic regression model patients with globus, voice change and gastric prolapse were more likely to respond to treatment (p <0.04).

It can be concluded that voice change, sore throat, globus and cough choking are the most reliable symptoms of laryngopharyngeal reflux. Voice change and globus symptoms can be of predictive value in terms of successful treatment response. Flexible oesophago-gastroscopy (FOG) isa simple, safe and reliable way of assessment in these cases and treatment with PPI can be effective in the majority of patients.

Treatment of the predisposing factors that are identified in the nose and throat in several ENT diseases is mandatory prior to the definitive management of the latter. When surgical management is indicated it has been traditional to use staged procedures. This study was undertaken to assess the role of concurrent surgical procedures in ENT and evaluate their cost-effectiveness compared to similar staged procedures. This was a retrospective case series of 100 consecutive patients undergoing concurrent and similar staged ENT surgical procedures. On analysis, it was noted that the average duration of surgery, anaesthesia and hospital stay was significantly less in the concurrent procedures group than in the staged procedures (2.35/3.1.hours; 3.05/3.30.hours and 2.5/6.5 days, respectively). The average hospital bill for the concurrent procedures was also lower than for the staged procedures. Hence, in patients requiring multiple ENT surgical procedures for definitive treatment, concurrent procedures are more cost-effective than staged procedures and should be considered the treatment of choice in a tertiary care centre.

The Internet has become a very important source of health information. We wanted to determine otolaryngology patients’ access to, and use of, the Internet as a medical information resource, to identify factors that make patients more likely to use it, and to determine how useful they find this information.

A questionnaire survey was completed by patients while waiting for their consultation in the out-patient department of the Royal National Throat Nose and Ear Hospital in London. Five hundred and thirty-five questionnaires were completed. Sixty-four per cent (344/535) reported having access to the Web. Of the 344 with access, 62 (18 per cent) had searched the Web for medical information prior to their consultation. Higher education (p <0.001) and age between 18 and 40 years (p = 0.001) correlated significantly with higher Internet use. Ninety-five per cent planned to use the Internet again.

Approximately one out of five otolaryngology out-patients with Internet access reported having obtained medical information from the Web before their consultation. The majority found it helpful to some degree and were planning to use it again. As clinicians we should be aware ofthis use and the onus should be on ourselves to review these sites in order to guide our patients to sources of reliable and helpful medical information on the Internet.

The aim of this study was to find out whether there is a consensus of opinion among healthcare providers and different sections of the public on the relative prioritization of common otolaryngological conditions for outpatient consultations and inpatient treatment. ENT consultants, general practitioners, administrators, NHS employees, non-ENT patients and members of the general public were given common scenarios of otolaryngological conditions and asked to prioritize them in order of importance. All the groups gave top priority for patients with suspected cancer of the larynx (outpatients) and for surgical treatment of cancer. Children with hearing problems were more commonly ranked in the top three categories than children requiring treatment for sore throats. All groups assigned those requiring rhinoplasty, treatment for snoring or hearing aids to the last three ranks. This study shows that there is a remarkable uniformity of opinion in determining clinical priorities which is similar to the traditional policies practised by UK ENT consultants.

Epistaxis has a reported prevalence of 10–12 per cent in the general population and is thus one of the commonest emergencies in Otolaryngology. We suggest that the patient uses a surgical mask to prevent blood spray during epistaxis management. Utilizing the described technique we have found that protective clothing worn by the healthcare professional is consistently ’blood-free’ atthe end of the procedure. This is in contrast to findings when no facemask is applied.

We report a patient who developed left ear pain, dry cough, and fever. The external auditory canal was tender, swollen, erythematous and full of debris. Later the patient developed widespread tender and red skin nodules and pustules that subsequently coalesced to form plaques. Identical lesions developed also in the external auditory canal and the tympanic membrane of the affected ear. Skin biopsy showed dermal neutrophilia, compatible with the diagnosis of Sweet’s syndrome. Rapid improvement was achieved with prednisone after the failure of antibiotics.

Fusobacterium necrophorum is implicated as an aetiological agent in a variety of necrotic diseases, such as Lemièrre’s syndrome (LS) in humans. LS was initially described as septic thrombophlebitis of the internal jugular vein secondary to an acute oropharyngeal infection. Other primary sources of infection include parotitis, otitis media, sinusitis, odontogenic infection and m stoiditis. In the pre-antibiotic era LS carried a high mortality. This has been reduced as a result of the widespread use of antibiotics, butthere is still a definite morbidity and mortality associated with infection with this virulent organism. We report three cases of complicatedotitis media caused by Fusobacterium necrophorum. The patients were treated successively with intravenous metronidazole and surgery.

In this article, a Wohlfahrtia magnifica otomyiasis case, a 31-year-old, non-mentally retarded patient who had undergone radical mastoidectomy previously is presented. Maggots in the radical mastoidectomy cavity were removed then topical treatment was applied. The maggots were identified as W. magnifica. In cases of myiasis, identification of larvae following direct extraction and application of preventative methods is essential.

A 59-year-old woman who presented with chronic headache, neck stiffness and left-sided hearing loss is reported. The diagnosis of angiostrongylus eosinophilic menigitis was made. The patient improved after treatment with prednisolone, including hearing.Angiostrongylus eosinophilic meningitis associated with sensorineural hearing loss has not previously been reported.

Pyomyositis (PM) is an uncommon cause of acute bacterial infection occurring in skeletal muscle. This disease is rare in non-tropical areas, and PM caused by Mycobacterium is very rare in a non-immunocompromised person. The presence of temporal area swelling may lead to a differential diagnosis toward more common pathologies, such as a complication of mastoiditis or a neoplasm of the temporal area. This article describes a case of tuberculous pyomyositis in a non-immunocompromised woman, the diagnosis of which was confirmed by sonographically guided fine-needle aspiration.

Primitive neuroectodermal tumour/extraskeletal Ewing’s sarcoma (PNET/EES) is a rare disease of the head and neck region. We report a case of a 74-year-old man with a laryngeal Ewing’s sarcoma. This is the first reported case of extraskeletal Ewing’s sarcoma of the larynx in an elderly male patient. The patient was successfully treated with surgical resection and post-operative radiotherapy.

Tuberculous mastoiditis is a well-documented entity with decreasing incidence in recent years. Tuberculous osteitis of the skull is even rarer. The case of a 58-year-old male with tuberculous mastoiditis complicated by extensive tuberculous osteitis of the skullis presented. This case serves to demonstrate both the difficulty in establishing the diagnosis of tuberculosis and the potentially disastrous consequences of the disease.