There is a paucity of high quality trials evaluating interventions for acute otitis externa. The results of this systematic review are largely based on odds ratios calculated from single trials, most of which have very broad 95% confidence intervals because of small to modest sample sizes. The findings may not be wholly generalisable to primary care for a variety of reasons; only two of the 19 trials included in the review were conducted in a primary care population setting, and in 11 of the 19 trials ear cleaning formed part of the treatment (an intervention unlikely to be available in primary care). Despite these reservations, some meaningful conclusions can be drawn from the evidence available:Topical treatments alone, as distinct from systemic ones, are effective for uncomplicated acute otitis externa. In most cases the choice of topical intervention does not appear to influence the therapeutic outcome significantly. Any observed differences in efficacy were usually minor and not consistently present at each follow-up visit. Acetic acid was effective and comparable to antibiotic/steroid at week 1. However, when treatment needed to be extended beyond this point it was less effective. In addition, patient symptoms lasted two days longer in the acetic acid group compared to antibiotic/steroid.The evidence for steroid-only drops is very limited and as yet not robust enough to allow us to reach a conclusion or provide recommendations. Further investigation is needed.Given that most topical treatments are equally effective, it would appear that in most cases the preferred choice of topical treatment may be determined by other factors, such as risk of ototoxicity, risk of contact sensitivity, risk of developing resistance, availability, cost and dosing schedule. Factors such as speed of healing and pain relief are yet to be determined for many topical treatments and may also influence this decision.Patients prescribed antibiotic/steroid drops can expect their symptoms to last for approximately six days after treatment has begun. Although patients are usually treated with topical medication for seven to 10 days it is apparent that this will undertreat some patients and overtreat others. It may be more useful when prescribing ear drops to instruct patients to use them for at least a week. If they have symptoms beyond the first week they should continue the drops until their symptoms resolve (and possibly for a few days after), for a maximum of a further seven days. Patients with persisting symptoms beyond two weeks should be considered treatment failures and alternative management initiated.

End-to-end anastomosis confers the best facial function, followed by cable nerve graft interposition and then classic faciohypoglossal transposition. Contrary to some previous opinions, improvement in facial function can still occur 2 years after surgical repair, particularly with classic faciohypoglossal transposition.

RapidRhino and Merocel are equally effective in the control of anterior epistaxis but RapidRhino is significantly more comfortable for the patient and easier for the healthcare worker during insertion and removal.

No abstract

The positive impact of surgical voice restoration on quality of life in the alaryngeal patient considerably outweighs the complications commonly associated with the procedure. Greater knowledge of the potential problems should continue to reduce the complication rate. Primary puncture, in a patient selected and subsequently managed in a multidisciplinary environment, would appear to provide the best outcome for the patient.

The otolaryngologist who requests magnetic resonance imaging (MRI) scans to exclude cerebellopontine angle (CPA) tumours may discover incidental pathologies. We retrospectively reviewed the results of 644 consecutive MRI screening scans with the aim of identifying findings other than CPA tumours. Two hundred and eighty-nine (45 per cent) scans featured one or more anomalies or abnormalities, including CPA tumour (23, four per cent), vascular loop (30, five per cent), basilar artery ectasia (13, two per cent), multiple high signal areas (135,21 per cent), brain atrophy (52, eight per cent), sinus findings (56, nine per cent), middle ear/mastoid disease (34, five per cent), and a variety of other findings (39, six per cent) including clinically serious lesions (11, two per cent). The significance and management of these incidental findings is discussed. The majority were not clinically significant but the occasional presence of a serious incidental pathology should be borne in mind. Basilar artery ectasia and multiple high signal areas may be responsible for the symptoms investigated by MRI, and screening for cerebrovascular disease risk factors in such patients may be appropriate.

Aims: To evaluate the role of magnetic resonance imaging (MRI) in the assessment of children with suspected extrinsic tracheobronchial compression due to vascular anomalies. Methods: Retrospective case note review in a tertiary referral centre. Twenty nine children who underwent dynamic laryngotracheobronchoscopy (DLTB) and were found to have a clinical suspicion of extrinsic tracheobronchial compression were evaluated. All subsequently underwent thoracic MRI within 10 days. The findings on endoscopy were compared to those of MRI, and where performed, echocardiography, aortography, and surgery. Results: There were 17 males and 12 females (mean age 5 months, range 28 weeks gestation to 60 months). The most common presenting features were stridor and cyanotic episodes. MRI showed abnormalities in 21 patients. There were five vascular rings (three double aortic arches and two right aortic arches) and 11 cases of innominate artery compression. Other vascular anomalies noted included aberrant right subclavian artery and aneurysmal left pulmonary artery. Echocardiography was generally found to be unhelpful in the diagnosis of extra-cardiac vascular abnormalities. Angiography was subsequently conducted in eight children; findings agreed with those shown on MRI. Surgery was performed on all five vascular rings, one innominate artery compression, and one aneurysmal left pulmonary artery. Surgical findings were also compatible with the preoperative MRI. Conclusions: This study shows the successful use of MRI as the initial imaging modality in endoscopically suspected extrinsic vascular compression of the upper airway. It enables accurate delineation of vascular anomalies and, unlike aortography, is non-invasive and does not require the use of contrast media.T horacic vascular anomalies are potentially life threatening but treatable causes of tracheobronchial obstruction in infancy. The resultant airway compromise occurs as a direct consequence of physical external compression of the airway lumen, but may also reflect the subsequent development of secondary tracheobronchomalacia.1 When symptomatic, these patients may present with stridor (commonly misdiagnosed as asthma), croup-like cough, recurrent lower respiratory tract infections, dysphagia, and episodic apnoea. As a consequence of the airway obstruction, the patient's ability to clear secretions from the airways distal to the level of compression may be compromised. The resulting accumulation of secretions increases both the risk of secondary infection and accompanying inflammation, which may result in airway irritation and a croup-like cough. 2Thoracic magnetic resonance imaging (MRI) is becoming increasingly popular as the first line imaging modality in the diagnostic workup of paediatric airway obstruction suspected to be due to vascular anomalies of the aortic arch system and its major branches.2-5 Advocates of MRI maintain that it is both non-invasive and can accurately differentiate the various forms of vascular tracheobronchial compression from other causes of ...

Endolymphatic sac tumours (ELST) are rare tumours of the petrous temporal bone. They may arise sporadically or be associated with von Hippel-Lindau disease. Their differential diagnosis is discussed. We present the clinical and histopathological features of two new patients with ELST and outline the management of their condition. In addition, we review a third case previously reported as a choroid plexus papilloma in which the histology has been re-assessed and the diagnosis changed to ELST. The controversy regarding the cellular origins of adenomatous tumours of the temporal bone is highlighted.