Despite advances in the diagnosis and treatment of acute frontal sinusitis, there is still significant occurrence of intracranial complications. Urgent surgical evacuation of any intracranial collection is required; however, the surgical management of the associated sinusitis remains controversial. Ten patients presented to this department over a 12-month period with subdural empyema secondary to acute frontal sinusitis. Four patients had a coexisting Pott's puffy tumour and one patient had a periorbital abscess. Each patient was managed using a multidisciplinary approach. A frontal sinus trephine/drain +/- antral washout was performed at the same time as craniotomy with evacuation of the empyema. With this approach only two patients suffered long-term morbidity in our series, in the form of persistent neurological or cognitive deficit. No patient required a definitive sinus procedure. This study emphasizes the need for the early assessment and intervention of patients with an intracranial complication secondary to acute frontal sinusitis. Further assessment of the underlying sinus disease is indicated during outpatient follow up after the acute episode.

Reportedcases ofrenal cell carcinoma metastatic to the nose or to the tongue are rare. No case of renal cell carcinoma metastatic to both sites has been previously described. In this article, we report what to our knowledge is the first such case. The nasal metastasis grew rapidlyand was treated with radioth erapy. Subsequently, a rapidly enlarging tongue metastasis developed, and it was removed via laser excision. Despite treatm ent, the patient died within 4 months of the diagnosis.

Our case demonstrates that pregnancy can lead to hearing loss in two sequential pregnancies. Mechanisms are discussed in detail. Clinically it appears that the hearing loss and tinnitus associated with pregnancy can spontaneously recover.

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Objective This study aimed to determine the awareness, otological symptoms and prevalence of external auditory canal exostoses in Irish cold-water athletes. Method An online and in person cross-sectional survey was undertaken with Irish cold-water athletes to explore athletes' awareness, known prevalence of external auditory canal exostoses and attitudes towards preventive measures. Results Of the 926 participants surveyed, 67.5 per cent were aware of external auditory canal exostoses. Triathletes reported the lowest awareness (39.9 per cent) among water athletes. A total of 9.7 per cent (n = 90) had previously been diagnosed with external auditory canal exostoses and 46.7 per cent (n = 42) were non-surfers. Ear symptoms were reported in 76 per cent of athletes. Otoscopic examinations showed that 23.7 per cent had external auditory canal exostoses, 3.6 per cent of whom were aware of their diagnosis. Conclusion The majority of Irish surfing athletes are aware of external auditory canal exostoses. There is less awareness with regard to Ireland's newly emerging sports such as open water swimming and triathlons. Over 90 per cent of athletes surveyed had no idea they had external auditory canal exostoses, which highlights the need to increase public awareness.

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Our results demonstrate strikingly low overall referral rates in this cohort, falling well below both the international benchmark and the initial results of the Irish UNHS programme. This provides a convincing argument for examining AABR as a potential alternative to TEOAE in the nationwide UNHS.

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