Due to the relatively high failure rates for both endonasal and external frontal sinus surgery, with a high post-operative incidence of frontal sinus outflow tract re-stenosis, long-term stenting is a useful option in carefully selected patients.

At three months, endonasal laser dacryocystorhinostomy had better results than endonasal surgical dacryocystorhinostomy. However, at 12 months, the surgical procedure had better results than the laser procedure. There was no statistically significant difference between the two groups at three or 12 months with regard to symptomatic outcome. The ease of procedure (on a scale of zero to 10) was 4.5 for the laser procedure and 4.1 for the surgical procedure. The average times for the procedures were 25 minutes in the laser group and 20 minutes in the surgical group. No statistical difference was found when comparing: symptom score improvement for local anaesthetic vs general anaesthetic; ages over and under 70 years; laterality; or operating surgeon. Change in the symptom score was a useful indicator of symptomatic success.

Disabling hearing impairment is the world's most common disability. Traditionally, hearing levels measured by pure tone audiometry have been used to define and quantify hearing loss. The effects of disabling hearing loss on patients' quality of life can be profound, and audiometric data alone may not correlate with quality of life measures. Generic measures of quality of life can be used to compare different diseases, and as such are useful in resource allocation and burden of disease studies. Their disadvantage is that they are not disease-specific and can therefore under-estimate the effects of a disease on patients' quality of life. Disease-specific measures are more sensitive. In chronic otitis media, additional factors such as discharge augment the effect of hearing loss alone on quality of life. Many of the quality of life measures developed for chronic otitis media have been used to assess improvement following reconstructive surgery. Quality of life measures have also been used to assess the effect of paediatric otitis media. Quality of life measures also have utility in the developing world, where hearing impairment is a huge burden.

Abstractobjectives Hearing impairment is a significant burden in the developing world. However, no suitable quality of life (QoL) measures exist for use in Nepal. We aimed to amend and translate the Glasgow Health Status Inventory (GHSI), assessing QoL at any given time, and the Glasgow Benefit Inventory (GBI), assessing change in QoL following intervention, into Nepali and to assess the impact of ear disease and effect of surgery on QoL.methods The GHSI and GBI were translated into Nepali and independently verified. The GHSI was administered by interview to patients before surgery, and the GBI was administered 6 months after surgery. The Mann-Whitney U-test was used for hypothesis testing.

Open cavity mastoidectomy remains the principal surgical treatment of middle ear cholesteatoma in the United Kingdom. A significant proportion of mastoid cavities are prone to intermittent or continuous discharge. In this study the histopathological features of material removed from 159 mastoid cavities at revision surgery were reviewed. Findings included squamous epithelium with acute and chronic inflammation, foreign body granuloma and aural polyps. Of particular note was the very infrequent finding of discharging cavities lined with respiratory epithelium, suggesting that retained mucosa in mastoid air cells is not a common cause of persistent otorrhoea.

Epistaxis is a common problem. Most patients presenting to hospital will stop bleeding with simple first-aid measures or with nasal packing. Those who do not stop will usually require surgical management. For persistent posterior epistaxis, the sphenopalatine artery may be ligated as the artery leaves the sphenopalatine foramen to enter the nasal mucosa of the lateral wall of the nose. This may be performed endoscopically. We describe the anatomy of the area and the surgical technique. We also present a brief review of the literature on this technique.

Introduction: Deafness is a major problem in developing countries. Rural communities tend to be affected more than urban ones, and chronic otitis media is common. The World Health Organization has proposed primary ear care as a method of providing otological services in developing countries. This study aimed to assess the diagnostic otoscopy skills of community ear assistants in rural Western Nepal.Materials and methods: Community ear assistants undertook the pre-operative evaluation of 92 patients selected for middle-ear surgery in an 'ear camp' setting. The otoscopy skills of community ear assistants were also assessed by means of an otoscopy quiz. Consultant otologists and trainee otolaryngologists underwent an identical assessment.Results: The community ear assistants' selection of patients for middle-ear surgery concurred with the consultant otologists' opinion in 87 of 92 patients (94.5 per cent). The level of community ear assistants' otoscopy skills was between that of junior and senior otolaryngology trainees.Conclusions: With intensive training, medically unqualified community ear assistants can develop otoscopy skills comparable to those of medically qualified otolaryngology trainees. These results support the development of primary ear care in poorer countries where access to specialist otological services is difficult or impossible.

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