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Mastoid surgery for cholesteatoma

Landmark Paper: Toner JG, Smyth GDL. Surgical Treatment of Cholesteatoma: a comparison of three techniques. Am J Otol 1990;11(4):247-9. Canal wall up or canal wall down? Chris Aldren discusses the landmark paper that attempted to provide a definitive answer for...

The pioneers of endoscopy and the sword swallowers

Adolf Kussmaul drew inspiration from an unlikely source to further the development of endoscopy… The early pioneers of airway endoscopy and oesophagoscopy were bedevilled by two major and seemingly insurmountable problems. One was the paucity of light sources, with reliance...

Balloon Eustachian tuboplasty

Eustachian tube dysfunction is a common condition, which is unfortunately lacking an effective treatment. This small study demonstrated the effectiveness of balloon Eustachian tuboplasty in a district hospital setting. It has been in use since 2010 and is beginning to...

Bad splits

This is a meta-analysis of reported risk factors of a ‘bad split’ in a sagittal split mandibular osteotomy. They identified 30 observational articles and therefore acknowledged it is based on low quality studies. It is compounded by the definition of...

High definition tractography to identify cranial nerves

It has always been challenging to visualise cranial nerves on traditional imaging as the cranial nerves have a fine structure and complex anatomy. This is especially true regarding the cochlear nerve. In congenitally hearing impaired children, the visualisation of the...

Anaesthesia for sleep nasendoscopy and snoring / obstructive sleep apnoea surgery

Surgery for sleep disordered breathing inevitably requires surgeon and anaesthetist to share the airway. Here, Edward Bick gives us the anaesthetic viewpoint, reiterating that communication is the key. A specific note is made of the anaesthetic technique for sleep nasendoscopy,...

Gadolinium enhanced MRI and the diagnosis of Ménière’s disease

Despite various criteria applied over the years to diagnose Ménière’s disease since the concept of endolymphatic hydrops was first observed in postmortem examinations of patients in 1938, the diagnosis still remains mainly clinical. To visualise endolymphatic hydrops in MRI imaging,...

Can and should vestibular schwannoma surgery be carried out via the endoscopic transcanal approach?

The extent and scope of endoscopic ear surgery has rapidly progressed in recent years, and this paper, from one of the leading proponents of this technique, reports on the outcomes of a case series of patients who have had total...

Inter-aural hearing preservation in cochlear implantation

Hearing preservation during cochlear implantation is becoming increasingly important, although results can be unpredictable. NICE are in the process of updating their guidance in the UK and it is possible that those with better hearing than the current candidates will...

Double suspension sutures for obstructive sleep apnoea

This study examines the benefit of an operation that targets the lateral pharyngeal wall. The double suspension sutures are, in essence, a suture through the palatopharyngeus muscle which is then tied around the hamulus in the retro molar area. This...

Advances in diagnosis and management of allergic rhinitis

This article reviews advances in the diagnosis and management of allergic rhinitis. Recent advances in the diagnosis of allergic rhinitis include testing of local immunoglobulin E (IgE), urinary test to diagnose aspirin hypersensitivity and optical rhinometry to assess degree of...

5-cm incision for neck dissection and free flap reconstruction

Patients with oral cavity squamous cell carcinoma (SCC) will commonly require neck dissection as it is associated with a higher rate of overall and disease free survival. Free flap reconstruction of the defect following surgical resection is considered the gold...