Screening for vestibular schwannoma in the context of an ageing population.

OBJECTIVE: To review the literature regarding screening for vestibular schwannoma in the context of demographic changes leading to increasing numbers of elderly patients presenting with asymmetric auditory symptoms. METHODS: A systematic review of the literature was performed, with narrative synthesis and statistical analysis of data where appropriate. RESULTS: Vestibular schwannomas diagnosed in patients aged over 70 years exhibit slower growth patterns and tend to be of smaller size compared to those tumours in younger age groups. This fact, combined with reduced life expectancy, renders the probability of these tumours in the elderly requiring active treatment with surgery or stereotactic radiotherapy to be extremely low. Vestibular schwannomas in the elderly are much more likely to be managed by serial monitoring with magnetic resonance imaging. The weighted yield of magnetic resonance imaging in the diagnosis of vestibular schwannoma in all age groups is 1.18 per cent, with almost 85 scans required to diagnose 1 tumour. CONCLUSION: An evidence-based approach to the investigation of asymmetric hearing loss and tinnitus in the elderly patient can be used to formulate guidelines for the rational use of magnetic resonance imaging in this population.

The ineffectiveness of applying moisture to the ear on the incidence and severity of otic barotrauma for air passengers.

OBJECTIVE: The application of moisture to the ear is anecdotally claimed to relieve the pain from otic barotrauma that can arise during aircraft descent. This claim was tested in a randomised double-blind study on an aircraft with eight participants heavily predisposed to barotrauma. METHODS: On the outward flight, half the participants wore 'active' devices that applied moisture to the external ear; the remainder wore placebo devices that contained no moisture, but were otherwise identical. On the return flight, the groups were reversed. Participants wore the devices from just before descent until landing, unless they experienced symptoms of barotrauma, in which case they switched to what they knew was an active device. RESULTS: There were no significant differences between conditions regarding the appearance of the tympanic membrane on landing or the discomfort levels immediately before and after any switch. CONCLUSION: Applying moisture is ineffective for passengers heavily predisposed to otic barotrauma.

Lasers in stapes surgery: a review.

BACKGROUND: Lasers in stapes surgery are used to divide the anterior and posterior crus of the stapes, divide the stapedius tendon and perforate the footplate. The ideal laser should not penetrate deeply into the perilymph (thereby increasing its temperature). It should be conducted through optical fibres, allowing easy manipulation, and should have good water absorption, equating to high bone ablation efficiency. OBJECTIVES: This review discusses the various different lasers used in stapes surgery with regard to their properties and suitability for this type of surgery. In particular, the laser parameters used are discussed to facilitate their clinical use.

Peri-operative cerebrospinal fluid leak during single-stage bone-anchored hearing aid implantation: case report.

BACKGROUND: A bone-anchored hearing aid uses the principle of bone conduction and osseointegration to transfer sound vibrations to a functioning inner ear. It consists of a permanent titanium implant, and removable abutment and sound processor. Informed consent requires discussion of the procedural benefits, alternatives and complications. The risks of bone-anchored hearing aid surgery include infection, soft tissue hypertrophy, skin graft or flap failure, osseointegration failure, and the need for further surgery. CASE REPORT: A case of cerebrospinal fluid leak in a patient undergoing bone-anchored hearing aid surgery is reported and discussed. CONCLUSION: Bone-anchored hearing aid surgery poses a risk of breaching the inner table of the temporal bone and dura, resulting in a cerebrospinal fluid leak; the risk of meningitis is rare but serious. The surgeon should discuss the possibility of cerebrospinal fluid leak when consenting patients. Pre-operative computerised tomography scanning should be considered in certain individuals to aid implant placement.

Air travellers' awareness of the preventability of otic barotrauma.

OBJECTIVE: Otic barotrauma is common among air travellers and can cause severe otalgia, perforation of the tympanic membrane and hearing loss. Many prevention measures exist, with varying evidence to support their use. There are no data to establish if air travellers are aware of them or indeed use them. We aimed to establish air travellers' knowledge of such prevention measures. METHODS: We surveyed air travellers at two UK airports by means of a questionnaire. Answers to the questionnaire were collected over a two-week period. RESULTS: Overall, 179 air travellers with a mean age of 28 years (range: 15-72 years) completed the questionnaire. There were 66 female and 113 male air travellers. The majority (84 per cent) complained of symptoms while flying and 30 per cent were not aware of any prevention measures. Barotrauma-related symptoms were reported in 25 per cent of air travellers who were unaware of any prevention measures. Nearly all air travellers (86 per cent) indicated that more information regarding prevention measures would be useful. CONCLUSION: Air travellers are often not aware of prevention measures to avoid otic barotrauma, and the majority suffer as a result. Increasing public awareness of simple prevention measures would have a significant impact on air travellers.

Aspergilloma of the middle ear mimicking necrotising otitis externa: case report.

OBJECTIVE: We report a case of a patient who presented with otalgia and facial nerve palsy secondary to an aspergilloma of the middle ear. CASE REPORT: A 72-year-old, diabetic man presented to the ENT department with a history of worsening right-sided otalgia, aural discharge and hearing loss, associated with a right-sided facial weakness. This was assumed to be secondary to malignant otitis externa, and treatment was commenced. Imaging showed soft tissue within the middle ear and no bony erosion. Surgical exploration and biopsy revealed an aspergilloma of the middle ear. The pre- and post-operative management, as well as treatment strategies, are discussed. CONCLUSION: To our knowledge, this is the first documented case of an aspergilloma of the middle ear with associated facial palsy. Readers are asked to consider this rare diagnosis in patients with suspected malignant otitis externa not responding to standard treatment.