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Objective: To determine whether theta burst repetitive transcranial magnetic stimulation is an effective treatment for chronic tinnitus compared with a control stimulus. Study Design: A two-arm, single-blind, randomized controlled trial comparing an active treatment group to a placebo control group. Setting: Neurotology department of a tertiary referral center. Patients: Forty new and existing patients with chronic unilateral or bilateral tinnitus were recruited from specialist hearing and balance clinics. Interventions: The subjects were randomized into two groups representing the treatment and sham subcategories. Two 40 second trains, 15 minutes apart of transcranial stimulation was provided using a super rapid stimulator (2.2. Tesla, Magstim Inc., Wales, UK) using a circular delivery coil. Treatment was provided over 5 consecutive days. Main Outcome Measure: Tinnitus functional index (TFI) scores were recorded before treatment, immediately after treatment, 2 weeks, and at 4 weeks following treatment and compared. Results: TFI scores were analyzed using the Shapiro–Wilk test and found to be normally distributed. A paired Student t test was then performed. Both the active treatment group and control group had a significant improvement in their TFI scores following treatment; however, there was no significant difference between active treatment and sham treatment groups. Conclusion: This study demonstrated a significant placebo effect following treatment with sham therapy and may suggest that repetitive transcranial magnetic stimulation does not have a therapeutic use in treating chronic tinnitus.

Thirty-two per cent of patients have keystone anatomy on radiology predisposing them to supratip depression with complete detachment of the OCJ. Relatively shorter nasal bones were significantly associated with a shorter, higher risk keystone area. In cases with a high septal deviation undergoing a septoplasty, a preoperative CT enables the surgeon to assess the keystone area and determine whether it is safe to completely detach the OCJ.

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There are significant variations in the anatomical and pituitary disease features between patients. We describe a number of features on pre-operative scans and have devised a checklist including a new 'teddy bear' sign to aid the surgeon in the anatomical assessment of patients undergoing trans-sphenoidal pituitary surgery.

Oesophageal duplication cysts are a rare congenital anomaly of the foregut which usually present in infancy with respiratory symptoms, recurrent pneumonia and feeding difficulty. Other presenting symptoms depend on the location of the cyst and can include dysphagia, chest pain, arrhythmias and features of mediastinal compression. Treatment is usually surgical resection, recommended for complete resolution of symptoms, histological diagnosis and exclusion of malignancy. Here, we present a case of infected oesophageal duplication cyst which presents as a neck lump in a 43-year-old female with a background of Goltz syndrome, azygos fissure and congenital aortic stenosis. Surgical resection was decided against owing to the patient's high risk secondary to co-morbidities and instead ultrasound guided drainage was carried out successfully. The patient was symptom free and well at 1-year follow-up. Oesophageal duplication is an unusual presentation of a neck lump in an adult and whilst the usual treatment is surgical resection, we present here a case treated in an entirely different manner.

No abstract

Objectives: Evaluate the accuracy of diffusion-weighted imaging magnetic resonance imaging (DWI-MRI) in diagnosis of cholesteatoma and the planning of surgery in our hospital. Methods: We conducted a retrospective study of all patients who had cholesteatoma surgery in our hospital from November 2007 until September 2013 that had undergone a DWI-MRI previous to the surgery. Results: A total of 24 patients were found. A total of 22 DWI-MRI findings were correctly correlated to findings in operation. There was 1 false positive where cholesteatoma was identified on imaging and mucosal disease was found in surgery; and 1 false negative that failed to identify a small cholesteatoma found during surgery. Of the 22 accurate correlations, 4 were of mucosal disease and the rest were correctly diagnosed as cholesteatomas. The DWI-MRI was able to localize the location of the cholesteatoma (from middle ear, attic, mastoid, aditus, hypotympanium and Eustachian tube) in 78% of the cases (14/18). Conclusions: DWI MRI is highly sensitive in the identification of the presence of cholesteatoma. Negative findings should be followed up because imaging sequences can miss cholesteatomas smaller than 3 mm. There is still a learning curve in the diagnosis and use of DWI MRI.