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Trauma involving the parotid gland is rare and is usually caused by penetrating injuries or fractures of the facial skeleton. A unique case is presented of rupture of the parotid gland after a minor external force in a 14 year old boy. The radiological findings are presented, which pointed to diffuse rupture of the gland parenchyma with an intact duct system. A conservative management policy using antibiotics and anticholinergics was effective, with complete resolution of symptoms. A literature review of more serious parotid injuries supported the conservative management policy. [ABSTRACT FROM AUTHOR]

Tinnitus is unusual for such a common symptom in that there are few treatment options and those that are available are aimed at reducing the impact rather than specifically addressing the tinnitus percept. In particular, there is no drug recommended specifically for the management of tinnitus. Whilst some of the currently available interventions are effective at improving quality of life and reducing tinnitus-associated psychological distress, most show little if any effect on the primary symptom of subjective tinnitus loudness. Studies of the delivery of tinnitus services have demonstrated considerable end-user dissatisfaction and a marked disconnect between the aims of healthcare providers and those of tinnitus patients: patients want their tinnitus loudness reduced and would prefer a pharmacological solution over other modalities. Several studies have shown that tinnitus confers a significant financial burden on healthcare systems and an even greater economic impact on society as a whole. Market research has demonstrated a strong commercial opportunity for an effective pharmacological treatment for tinnitus, but the amount of tinnitus research and financial investment is small compared to other chronic health conditions. There is no single reason for this situation, but rather a series of impediments: tinnitus prevalence is unclear with published figures varying from 5.1 to 42.7%; there is a lack of a clear tinnitus definition and there are multiple subtypes of tinnitus, potentially requiring different treatments; there is a dearth of biomarkers and objective measures for tinnitus; treatment research is associated with a very large placebo effect; the pathophysiology of tinnitus is unclear; animal models are available but research in animals frequently fails to correlate with human studies; there is no clear definition of what constitutes meaningful change or "cure"; the pharmaceutical industry cannot see a clear pathway to distribute their products as many tinnitus clinicians are non-prescribing audiologists. To try and clarify this situation, highlight important areas for research and prevent wasteful duplication of effort, the British Tinnitus Association (BTA) has developed a Map of Tinnitus. This is a repository of evidence-based tinnitus knowledge, designed to be free to access, intuitive, easy to use, adaptable and expandable.

Objectives: Tinnitus is a prevalent condition, but little has been published regarding the natural history of the condition. One technique for evaluating the long-term progression of the disease is to examine what happens to participants in the no-intervention control arm of a clinical trial. The aim of this study was to examine no-intervention or waiting-list data reported in trials, in which participants on the active arm received any form of tinnitus intervention., Data Sources: CINAHL, PsychINFO, EMBASE, ASSIA, PubMed, Web of Science, Science Direct, EBSCO Host, and Cochrane., Methods: Inclusion criteria followed the PICOS principles: Participants, adults with tinnitus; Intervention, none; Control, any intervention for alleviating tinnitus; Outcomes, a measure assessing tinnitus symptoms using a multi-item patient-reported tinnitus questionnaire. Secondary outcome measures included multi-item patient-reported questionnaires of mood and health-related quality of life and measures that quantified change in tinnitus loudness; Study design, randomized controlled trials or observational studies utilizing a no-intervention or waiting-list control group. Data were extracted and standardized mean difference was calculated for each study to enable meta-analysis., Results: The evidence strongly favored a statistically significant decrease in the impact of tinnitus over time, though there was significant heterogeneity and clinical significance cannot be interpreted. Outcome data regarding secondary measures did not demonstrate any clinically significant change., Conclusions: Participants allocated to the no-intervention or waiting-list control arm of clinical trials for a tinnitus intervention show a small but significant improvement in self-reported measures of tinnitus with time; the clinical significance of this finding is unknown. There is, however, considerable variation across individuals. These findings support previous work and can cautiously be used when counseling patients. Laryngoscope, 128:217-227, 2018., (© 2017 The American Laryngological, Rhinological and Otological Society, Inc.)

There are a number of auditory symptom syndromes that can develop without an organic basis. Some of these, such as nonorganic hearing loss, affect populations similar to those presenting with functional somatosensory and motor symptoms, while others, such as musical hallucination, affect populations with a significantly different demographic and require different treatment strategies. Many of these conditions owe their origin to measurably abnormal peripheral sensory pathology or brain network activity, but their pathological impact is often due, at least in part, to overamplification of the salience of these phenomena. For each syndrome, this chapter briefly outlines a definition, demographics, investigations, putative mechanisms, and treatment strategies. Consideration is given to what extent they can be considered to have a functional basis. Treatments are in many cases pragmatic and rudimentary, needing more work to be done in integrating insights from behavioral and cognitive psychology to auditory neuroscience. The audiology literature has historically equated the term functional with malingering, although this perception is, thankfully, slowly changing. These disorders transcend the disciplines of audiology, otorhinolaryngology, neurology and psychiatry, and a multidisciplinary approach is often rewarding., (© 2016 Elsevier B.V. All rights reserved.)

Objectives/hypothesis: Flexible nasolaryngoscopy is an essential skill for otolaryngology trainees to develop, but there is a lack of standardized training for this procedure. The aim of this study was to assess whether using training on a realistic human mannequin together with structured video feedback improved trainees' performance at flexible nasolaryngoscopy., Study Design: Three-armed, single-blinded, randomized controlled study., Methods: Thirty-six junior doctors and final-year medical students were randomly allocated to one of three groups. All received a lecture and video presentation on flexible nasolaryngoscopy. One group received additional tuition using a training mannequin. The last group received mannequin training and feedback on their performance using a video recording. The trainees then undertook flexible nasolaryngoscopy on volunteers with these endoscopies recorded. Blinded observers scored the trainees on a range of objective and subjective measures. The volunteers who were also blinded to the candidates' training scored the comfort of the procedure., Results: Adding mannequin training showed a trend toward improvement of performance but did not reach statistical significance. Mannequin training together with video feedback produced significant performance improvement in patient comfort (P = .0065), time to reach the vocal folds (P = .017), and global ability (P = .0006). Inter-rater reliability was excellent with P < .01 in all assessments., Conclusions: Simulation-based training using an anatomically correct model of the upper airway together with formalized video-assisted feedback on that training is a simple and effective way to improve endoscopy skills prior to starting flexible nasolaryngoscopy on patients., (© 2014 The American Laryngological, Rhinological and Otological Society, Inc.)

Acoustic shock is a recently recognised clinical entity: following an abrupt, intense and unanticipated acoustic stimulus, usually delivered by a telephone handset or headset, some individuals report a symptom cluster that includes otalgia, altered hearing, aural fullness, imbalance, tinnitus, dislike or even fear of loud noises, and anxiety and/or depression. Symptoms start shortly after the triggering acoustic incident and can be short-lived or can last for a considerable time. If persistent, the condition can lead to significant disability. Proposed mechanisms include involvement of the tensor tympani muscle, hyperexcitability of central auditory pathways, and a precursive state of raised anxiety or arousal. A formal treatment programme has not yet been proposed, but the potential utility of modern therapeutic techniques for tinnitus and hyperacusis are considered. Given the large number of UK residents working in telephone call centres, this condition is of considerable clinical importance.

Chronic idiopathic subjective tinnitus is a common condition affecting around one in ten of the population at any given time. For the majority of people it is an annoyance rather than a major health issue but for approximately 0.5 per cent of the population tinnitus interferes with their ability to pursue a normal life. Modern theories of the pathogenesis of the condition concentrate on the central auditory system although the peripheral auditory system can be a trigger or ignition site for tinnitus. Although a cure remains elusive there are several good treatment strategies based on psychological and neurophysiological models of tinnitus that promote habituation to the symptom.

Background: Tinnitus is described as the perception of sound or noise in the absence of real acoustic stimulation. It has been compared with chronic pain, and may be associated with depression or depressive symptoms which can affect quality of life and the ability to work. Antidepressant drugs have been used to treat tinnitus in patients with and without depressive symptoms., Objectives: To assess the effectiveness of antidepressants in the treatment of tinnitus and to ascertain whether any benefit was due to a direct tinnitus effect or a secondary effect due to treatment of concomitant depressive states., Search Strategy: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) The Cochrane Library Issue 1, 2006); MEDLINE (January 1951 to 2006); EMBASE (1974 to 2006), CINAHL (to 2006), PSYCINFO (to 2006), LILACS (to 2006), and Cambridge Scientific Abstracts. The date of the most recent search was March 2006., Selection Criteria: Randomised controlled clinical studies of antidepressant drugs versus placebo in patients with tinnitus., Data Collection and Analysis: The studies retrieved were critically appraised and data extracted independently by two authors. Where necessary study authors were contacted for further information., Main Results: Five trials involving 525 patients were included. Four of these trials looked at the effect of tricyclic antidepressants on tinnitus, investigating 405 patients. One trial investigated the effect of a selective serotonin reuptake inhibitor (SSRI) in a group of 120 patients. No trials involving other antidepressant agents met the inclusion criteria. Only the trial using the SSRI drug met the highest quality standard. None of the other included trials met the highest quality standard, due to use of inadequate outcome measures, large drop out rates or failure to separate the effects on tinnitus from the effects on symptoms of anxiety and depression. All the trials assessing tricyclic antidepressants suggested that there was a slight improvement in tinnitus but these effects may have been attributable to methodological bias. The trial that investigated the SSRI drug found no overall improvement in any of the validated outcome measures that were used in the study although there was possible benefit for a subgroup that received higher doses of the drug. This observation merits further investigation. Reports of side effects including sedation, sexual dysfunction and dry mouth were common., Authors' Conclusions: There is insufficient evidence to say that antidepressant drug therapy improves tinnitus.

A rare case of a smooth muscle tumour in the pharynx is reported, together with histopathological findings. The patient's psychiatric background and recurrent complaint of a sensation of a lump in the throat all pointed to a psychogenic aetiology, and diagnosis was delayed. The importance of mirror or endoscopic examination of the pharynx is stressed in patients with globus pharyngeus symptoms.

Tympanometry is well established as a useful tool in the field of otological diagnosis. There have been sporadic reports, however, of bizarre tympanograms in the presence of small perforations of the tympanic membrane. A model of the outer and middle ears was fabricated which was able to produce normal and pathological tympanograms. This model was used to investigate tympanometry in the presence of microperforations. A hypothesis for the mechanism of generation of sawtooth tympanograms in the presence of micro-perforations is postulated.

Cavernous haemangiomas are rare lesions of the cerebello-pontine angle that can mimic the more commonly occurring vestibular schwannoma. A case report involving a patient with a cavernous haemangioma of the internal auditory canal (IAC) highlights this as a diagnostic possibility for lesions of the IAC by comparing and contrasting the clinical and radiological findings with the more commonly occurring vestibular nerve and facial schwannomas. Symptoms such as hearing loss and facial paralysis that are disproportionate to the size of the lesion or fluctuate with hormonal changes such as those seen in pregnancy are suggestive of haemangioma. Radiological imaging demonstrating a lesion enhancing with gadolinium and containing areas of calcification is also suggestive of haemangioma. It is important to consider the possible diagnosis of haemangioma as early recognition of this entity may improve the chances of preserving the functional integrity of the facial nerve.

Obliteration of old mastoids and wet middle ears with autologous abdominal fat seems to be a reliable technique to render chronically discharging mastoid cavities or open middle ears dry and closed. This paper is the third in the series and looks at the intermediate results at five years. Of the 16 patients (one bilateral) 94.1 per cent of the ears are still dry and uninfected with closed external meati. Recurrent cholesteatoma was found in two patients at implantation and removed.

Tinnitus is a common symptom in adults and there is a wealth of published information on the pathogenesis and management of the condition. Tinnitus in childhood is likewise quite common when children are directly asked about the symptom. However, children rarely spontaneously complain of tinnitus. Little is known about effective management strategies for paediatric tinnitus. We review the literature regarding the prevalence and nature of paediatric tinnitus and suggest a logical and practical approach to managing this symptom.

Endoscopic sinus surgery (ESS) is a technique which carries great potential benefits for the treatment of many nasal conditions. However, it also carries substantial risks. The key to safe surgery lies with adequate training. A survey carried out as part of a North (East) Thames Region audit of higher surgical trainees revealed large discrepancies in their training and in their subsequent clinical practice. Almost half the trainees had started ESS without having been on a training course or performed any cadaver dissections. Despite the potential hazards of ESS, audit of complications and outcome received a low priority. The trainees made several suggestions for improving training, including better provision of courses, regional training programmes and improved access to cadavers for dissection. Other surgical specialties are being forced to examine the prospect of specific accreditation for minimally invasive techniques and otorhinolaryngology may have to follow suit.

A case of sudden sensorineural hearing loss in association with a Chlamydia psittaci pneumonia is reported. Rapid recovery was seen when the patient was treated with high dose steroids and appropriate antibiotics. This is the first such case report in the literature.

Polycystic disease of salivary glands is a rare condition which hitherto has been reported only in the parotid glands. We report a case in which an accessory salivary gland had evidence of polycystic disease.

The case records and histology of 34 patients with vocal process granulomata were reviewed. The five patients presenting most recently with idiopathic vocal process granulomata were investigated by axial computerized tomography (CT). Increased density of the arytenoid cartilage on the side of the lesion was found in all five cases. It is suggested that this indicates cartilage ossification, secondary to perichondritis. This perichondritis, playing either a primary or a secondary role in granuloma development, may explain the annoying tendency of vocal fold granulomata to recur after excision.

Fifty-nine unusual cerebello-pontine angle tumours have been studied. These lesions represent 19.3 per cent or 1 in 5 of a series of 305 cerebello-pontine angle tumours of which the rest, 246 (80.7 per cent), were acoustic neuromas. An analysis of the relative incidence, histology and presenting clinical features has been carried out. The various radiographical features and imaging techniques used to diagnose these fascinating tumours have been described and also the otoneurosurgical procedures necessary to excise them.

Congenital salivary fistulae are rare and may be associated with abnormalities of the branchial apparatus or arise from aberrant or accessory salivary tissue. Previous case reports have documented cutaneous fistulae. We report a case of a salivary fistula between the submandibular gland and the oropharynx and discuss a possible embryological basis for the abnormality.

Inflatable balloon catheters are widely used in the treatment of severe epistaxis and are designed to be filled either with air or liquid. A postal survey revealed that 87 per cent of respondents used an inflatant which was deemed inappropriate by the manufacturer. When balloons designed for water or saline were filled with air, they deflated rapidly, in some cases being virtually empty after 24 hours. Better and more accessible instruction leaflets are required if the balloons are to be used as intended. Foley catheters are frequently used as nasopharyngeal packs, in conjunction with anterior nasal packs. Paraffin in the commonly used anterior packs damages the rubber of the catheter, resulting in the balloon bursting. This should be recognized by clinicians as a possible cause of rebleeding.

The temporal bone may be involved by primary or secondary neoplasms. The latter are uncommon but well documented in the literature, the usual primary sites being breast, kidney, lung, stomach, larynx and prostate (Schuknecht et al., 1968). Lymphoma rarely invades the temporal bone and is usually confined to the lymphoreticular system and gastrointestinal tract. A case of non-Hodgkins lymphoma of the temporal bone is presented.

Two cases of infratentorial arteriovenous malformations that were occult to angiography but detected by computed tomography are discussed. In both cases a preoperative diagnosis of low-grade glioma was considered. Attention is drawn to the relative paucity of such lesions below the tentorium.

This case report describes the clinical course of a patient with Ramsay Hunt Syndrome. Partial recovery of the lower motor neuron facial palsy was associated with decreased hearing and a reduction of the middle ear compliance on voluntary contraction of the facial musculature. It is suggested that this is due to misdirection of regenerating nerve fibres, normally destined for facial muscles, to stapedius muscle.