Using a new otologic database, our series confirms that stapedotomy with vein graft interposition for otosclerotic stapes fixation is a safe and successful treatment for long-term hearing improvement. The deterioration in hearing with time after stapedotomy did not exceed the rate of hearing loss because of presbyacusis. Therefore, argon laser stapedotomy with vein graft interposition is our preferred surgical technique in the treatment of otosclerosis. Obliterative otosclerosis and simultaneous malleus ankylosis may be encountered during stapedotomy. Our study shows that reasonable success rates can still be expected in these situations. Stapedotomy results in the elderly and in children are comparable to those obtained in patients of other groups of age undergoing surgery for otosclerosis without an increased risk for complications.

The available evidence suggests that non-EPI such as half-Fourier acquisition single-shot turbo spin echo sequences are more reliable in identifying residual or recurrent cholesteatoma. This is a promising radiologic investigation; however, we think further studies are required with more patients and long-term results to establish its place as an alternative to a second-stage surgery after canal wall up surgery.

Idiopathic intracranial hypertension (IIH) is defined as increased intracranial pressure in the absence of intracranial mass or obstructive hydrocephalus. Over 80% of patients are overweight women. IIH is usually encountered in the neurology and ophthalmology practise as headaches, visual disturbance and papilloedema are the characteristic features of this syndrome. Patients with IIH also experience tinnitus, hearing loss, balance disturbance, cerebrospinal fluid (CSF) otorrhoea or rhinorrhoea and in some cases these otorhinological symptoms can be presenting features of this syndrome. IIH is also associated with obstructive sleep apnoea. Otolaryngologists should be familiar with this important condition as it can manifest a variety of symptoms that are more frequently seen in their clinics. Sometimes otolaryngologists may be involved in the surgical management of this condition, such as repair of CSF rhinorrhoea or otorrhoea or endoscopic optic nerve decompression. The aim of this review article is to familiarise the otolaryngologists with the important features of this unusual syndrome which may remain unrecognised in the otolaryngology practice.

This study included 25 adult patients (mean age at implantation 57.5 years). There was a statistically significant improvement in the average SSQ score in all three sections of the questionnaire with the use of the BAHA. Our patients experienced most marked benefits in speech hearing in challenging listening situations. All patients remain consistent users and there has been no explantation to date.

Diffusion-weighted (DW) MRI has recently increasingly gained popularity in the diagnosis of post-operative cholesteatoma. The aim of this study is to prospectively evaluate the usefulness of echo-planar imaging (EPI) for the diagnosis of residual cholesteatoma. Fifty patients underwent DW-EPI before surgery. Fifteen patients had a scan before their first surgery and 35 patients underwent neuroimaging prior to their second look surgery. In the first preoperative group of 15 patients, DW-EPI confirmed cholesteatoma in all the patients. In the post-operative group DW-EPI identified or excluded cholesteatoma correctly in 29 out of 35 patients. Our study has demonstrated a sensitivity of 83% and specificity of 82% of DW-EPI for the diagnosis of residual cholesteatoma. DW-EPI can be a value imaging modality and may help the surgeon in selecting patients for revision surgery.

This review discusses the various different lasers used in stapes surgery with regard to their properties and suitability for this type of surgery. In particular, the laser parameters used are discussed to facilitate their clinical use.

Infiltration of lignocaine with epinephrine is used with cocaine in septoplasty, in attempt to improve haemostasis and thereby improve the surgical field. This practice is widespread despite the lack of evidence to support its efficacy in the literature. Thirty patients undergoing septoplasty were randomised into two groups -- one in whom infiltration was performed with lignocaine (2%) with adrenaline (1:80,000) and a control group who received lignocaine (2%). Both groups of patients received intranasal application of cocaine paste prior to surgery. The surgeon and anaesthetist were blinded to the contents of the infiltration. The operative field was rated by the surgeon, and the blood loss calculated. No significant difference was demonstrated in blood loss or surgical field between the groups. However there was significant rise in systolic blood pressure in patients who received epinephrine. The use of epinephrine with cocaine paste does not improve haemostasis or surgical field. As the use of epinephrine is associated with cardiac arrhythmias, the authors suggest that combined use of cocaine paste and epinephrine infiltration should be avoided in septal surgery.

Upper esophageal perforation is a rare complication of an endoscopic ultrasound scan and, to our knowledge, there have been no reported cases of hypopharyngeal perforation. The risk factors, incidence, and management of perforations are reviewed. Early recognition of hypopharyngeal perforation is important and, in selected cases, immediate repair of the defect can lead to a good result.