John S. Phillips

A new health-related quality of life measure for active chronic otitis media (COMQ-12): development and initial validation.

Objective To develop and document for clinical use a new HRQoL questionnaire for the assessment of active chronic otitis media. Study Design Two-center prospective correlational study. Setting Two otology referral centers in England. Patients Fifty consecutive adult patients with a history of active chronic otitis media. Results Consistency criteria (Cronbach’s alpha) and first principle component loadings showed satisfactory scoring with 11 of the original 12 items. A single factor was obtained correlating highly with simple unweighted scoring. Conclusion Sufficient consistency and initial validity information was obtained from patients with a history of active chronic otitis media to justify clinical use of the reduced item set and acquisition of further data to refine scoring.

Migraine and Vertigo: A Marriage of Convenience?

“Migraine associated vertigo” is emerging as a popular diagnosis for patients with recurrent vertigo. However, in view of our current understanding of both migraine and vertigo, “migraine associated vertigo,” in contrast to basilar artery migraine, is neither clinically nor biologically plausible as a migraine variant.

The Prevalence and Onset of Gaze Modulation of Tinnitus and Increased Sensitivity to Noise After Translabyrinthine Vestibular Schwannoma Excision

Objective: To determine the prevalence and timing of onset of gaze-modulated tinnitus and increased sensitivity to noise in patients who had undergone translabyrinthine excision of a vestibular schwannoma. Study Design: Retrospective questionnaire study. Setting: University hospital departments of audiology and neurotology. Patients: A cohort of 359 patients who had undergone translabyrinthine excision of a vestibular schwannoma in the period 1997 to 2003. Intervention: Translabyrinthine excision of a unilateral sporadic vestibular schwannoma. Main Outcome Measures: Patient reports and visual analogue scale measures of the timing of onset of gaze-modulated tinnitus and the presence, timing of onset, and persistence of increased sensitivity to noise after surgery. Results: Completed questionnaires were returned by 275 patients (77%), of whom 132 (48%) were men and 143 (52%) were women. Preoperative tinnitus was reported in 150 patients (55%). In 124 of these 150 (83%) the tinnitus persisted, and in 26 of 150 (17%) it abated. Of the 125 patients without preoperative tinnitus, 43 (34%) developed it postoperatively. In 167 (61%) patients of the total group of 275, postoperative tinnitus was reported. Gaze-modulated tinnitus was reported in 53 patients (19%). Somatic-evoked or -modulated tinnitus was reported in 38 patients (14%). In response to the question, “Did you notice being extra sensitive to noise after your operation?,” 138 patients (50%) replied that they did. In 111 patients, this persisted. The onset of the modulation of tinnitus was distributed throughout the postoperative period, whereas the onset of increased sensitivity to noise was overwhelmingly in the first 2 months after surgery. Conclusion: Gaze modulation of tinnitus after vestibular schwannoma removal was identified in 19% of patients in this series. The onset data did not convincingly argue for any specific mechanism. The prevalence of increased sensitivity to noise is surprising and may represent central hyperacusis in response to unilateral deafferentation of the auditory system.

COMQ-12 scores in adult patients without chronic middle ear disease

To determine the COMQ‐12 score in an adult population without active COM.

Multifocal multi-site Warthin tumour

The unique case of a 55-year-old man with multifocal adenolymphoma (Warthin’s tumour) of both parotid glands, the neck and post-nasal space is presented. Warthin tumour is almost exclusively a parotid tumour but is known to be bilateral in 7–10% of cases and multifocal in 2% of cases. Most extraglandular Warthin tumours have been located in neck lymph nodes and only a few cases have been reported from other sites. The presented case is unique in having synchronous and metachronous Warthin tumours, as well as one of the tumours being neither truly parotid, nor within a lymph node.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) presenting with sudden sensorineural hearing loss

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is an autosomal dominant angiopathy characterized by recurrent cerebrovascular events, migraine and dementia. We describe a case of sensorineural hearing loss as the presenting feature of this condition. We have found no previous reports in the world literature of CADASIL presenting with a sudden sensorineural hearing loss. The significance of questioning a patient with regard to family history is exemplified in this case.

Myringoplasty outcomes in the UK.

OBJECTIVES To determine the outcome of myringoplasty as undertaken by ENT surgeons in the UK, and to assess the current systems available for providing national outcome data. METHODS A prospective national multicentre audit was conducted involving multiple hospitals throughout the UK. Participants consisted of ENT surgeons practising in the UK. RESULTS Data were prospectively collected over a three-year period between 1 March 2006 and 1 March 2009 using the web-based Common Otology Database. In total, 33 surgeons provided valid and complete data for 495 procedures. The overall closure rate for myringoplasty was 89.5 per cent. The average hearing gain for successful primary myringoplasties was 9.14 dB (standard deviation = 10.62). The Common Otology Database provided an effective platform for capturing outcome data. CONCLUSION Myringoplasty is a safe and effective procedure in the UK. With the introduction of revalidation by the General Medical Council, participation in national audits will be mandatory in the future. This study demonstrates that a web-based audit tool would be suitable for performing such audits.

Expert bias in peer review.

Peer review before publication is a pivotal process that can facilitate the selection of appropriate manuscripts for publication in scientific journals. This system may involve a number of procedures that serve to judge the suitability of the material being submitted in relation to the remit of the journal, as well as a process by which the scientific content undergoes critical appraisal by appropriately qualified experts in that field. Editors and scientists alike agree that scientific scrutiny is key; however, the system is not perfect and accusations have been made that manuscripts may be assessed more on the basis of acceptability rather than validity. The concept of publication bias has been well described, particularly with respect to the reporting of a significant outcome, leading to the term ‘bias against the null hypotheses’. However, a bias that arises from an expert’s predilection for one opinion rather than another has received far less attention. This editorial will attempt to shine a light on expert bias in peer review and offer solutions for overcoming the problem.

Otosyphilis: a neglected diagnosis?

The widespread introduction of penicillin in the postwar years, alongside the introduction of antenatal screening for infectious diseases, has led to the popular belief that luetic disease is an historical malady, consigned to the textbooks. Despite a decline during the antibiotic era, the incidence of syphilis has seen an alarming rise, with Public Health England (formerly the Health Protection Agency) reporting a 12-fold increase in the annual diagnosis of infectious syphilis between 1997 and 2007 (1). Between 1999 and 2008, the majority of the diagnoses of infectious syphilis have been made in men who have sex with men (MSM), but in contrast to MSM, the pattern of infection in heterosexuals has changed since 1999. At the beginning of the epidemic heterosexual transmission involved imported infections, commercial sex work, and sex parties (2). However, by 2008, the majority of infections were acquired within the UK. Between 1999 and 2007, diagnoses of infectious syphilis in women more than doubled, and as a consequence of this cases of congenital syphilis have reemerged. Infection rates are also rising in North America, the rest of Western Europe, Asia, Australia, and New Zealand (3). The incidence of syphilis in the United States has nearly doubled since 2000. In Denmark, diagnoses of infectious syphilis increased by more than 50% between 1999 and 2002, and in Belgium, a 3toI5-fold increase in the number of laboratory-diagnosed syphilis cases was detected between 2000 and 2002 (3). Other major urban centers such as London, Dublin, Berlin, Paris, and Rotterdam also reported huge increases in syphilis during this period (3). Worldwide, the World Health Organization estimates that approximately 12 million new syphilis infections occur each year, many of which go untreated (4). Syphilis, caused by the spirochete Treponema pallidum, is transmitted predominantly through sexual contact or vertically from mother to fetus. It is notorious for its ability to manifest with a diverse array of symptoms in any of the major body systems, giving rise to the moniker of ‘‘The Great Mimic.’’ Otosyphilis was once worthy of being reported as small case series, thereby affirming its status as a rarity. Apathy toward syphilis testing has therefore resulted, and the diagnosis of syphilis as a cause of audiovestibular symptoms may well be missed (5). Increased awareness of the role of syphilis in ear disease has been raised within the sexual health community (6), but this awareness has not been reflected among ENT specialists. Missing a diagnosis of otosyphilis not only has prognostic implications but also increases the risk of further damage to other body systems. There are also wider public health implications to be considered, including the institution of contact tracing.

A unified hypothesis for vestibular dysfunction

It is our hypothesis that three distinct syndromes of vertigo (ie, labyrinthitis, Ménières disease, and BPPV), which arise from a malfunction of the vestibular labyrinth, are in fact a spectrum of disorders all resulting from the presence of free-floating particles within the vestibular fluid chambers.