Vitamin D and smell impairment: a systematic literature review.

OBJECTIVE: Smell impairment affects 60-80 per cent of individuals aged over 80 years. This review aimed to identify any association between vitamin D deficiency and smell impairment, and determine the efficacy of vitamin D to treat smell impairment. METHODS: A literature search was conducted across four databases between the years 2000 and 2022. The literature screen was performed by two independent reviewers. RESULTS: Seven articles were included in this review. Four studies examined the association between vitamin D deficiency and smell impairment, with three studies identifying a significant relationship. Three studies investigated the use of vitamin D as treatment for smell impairment, which found complete resolution or significant symptom improvement after vitamin D deficiency was treated. CONCLUSION: This review identified limited studies on this topic. As vitamin D supplementation is relatively cost-efficient, further large-scale studies should be carried out to investigate the efficacy of vitamin D for treating anosmia.

Petrous apex pneumatisation in children: a radiological study.

OBJECTIVE: This study aimed to investigate petrous apex pneumatisation in children, as an understanding of petrous apex pneumatisation is useful in the diagnosis and surgical management of middle-ear disease. METHODS: Computed tomography head scans from 1700 patients aged 0-16 years were assessed. Petrous apex bone and air cell volumes were calculated to determine the degree of petrous apex pneumatisation. Scans were analysed for communicating tracts between the middle ear and petrous apex. RESULTS: Petrous apex pneumatisation was found in 21.0 per cent of patients. Positive relationships were found between age and petrous apex pneumatisation prevalence (rs = 0.990, p < 0.001), and between age and degree of petrous apex pneumatisation (rs = 0.319, p < 0.001). Petrous apex pneumatisation prevalence did not significantly differ by sex or ethnicity. Communicating tracts were identified in 84.3 per cent of patients with petrous apex pneumatisation, most commonly anterior to the otic capsule. CONCLUSION: In children, the prevalence and degree of petrous apex pneumatisation increases with age, but prevalence is not affected by sex or ethnicity.

The importance of petrous apex and peri-carotid pneumatisation in subtotal petrosectomy and blind sac closure: a radiological study.

OBJECTIVE: To ascertain in what proportion the vertical segment of the intratemporal carotid artery on its medial aspect anatomically separates the peri-tubal cells and Eustachian tube from the remainder of the pneumatised spaces of the temporal bone. METHOD: A retrospective review was conducted of 222 adult and 29 paediatric consecutive computed tomography scans of petrous temporal bones from a single tertiary referral centre. RESULTS: In 96 per cent of temporal bones, the carotid artery formed a lateral barrier (with no communication pathway medially) between air spaces anterior and posterior to it. This equated to 94 per cent when chronic otitis media cases were excluded. CONCLUSION: The degree of separation of middle-ear air cells from the Eustachian tube or nasopharynx, and the relevant anatomy, are reviewed. This knowledge helps to optimise the outcome of subtotal petrosectomy and blind sac closure. The frequency and process of pneumatisation of the petrous apex, and its connections with the middle ear, have been radiologically confirmed.

Recent advances in superior semicircular canal dehiscence syndrome.

OBJECTIVE: This study aimed to review the current advances in superior semicircular canal dehiscence syndrome and to ascertain its aetiology, whether dehiscence size correlates with symptoms, signs and investigation results, the best investigations, and its surgical management. METHODS: A literature search using the key words 'superior semicircular canal dehiscence' was performed using the Allied and Complementary Medicine Database and the Embase, Health Management Information Consortium, Medline, PsycINFO, British Nursing Index, Cinahl and Health Business Elite databases for the period January 2009 to May 2014. Systematic reviews, meta-analyses, randomised controlled trials, prospective and retrospective case series, case reports, and observational studies were included. RESULTS: Of the 205 papers identified, 35 were considered relevant. CONCLUSION: The aetiology of superior semicircular canal dehiscence syndrome is unclear. Dehiscence size significantly affects the air-bone gap and ocular vestibular evoked myogenic potential thresholds. Computed tomography evaluation has a high false positive rate. The middle cranial fossa approach is the surgical standard for treating this syndrome; however, the transmastoid approach is gaining popularity.

The perils of paint-balling.

While paint-balling a 15-year-old boy was shot on the front of his face guard causing him to hyperextend his neck. Over the next few days he developed neck stiffness and a large painful swelling over his upper left sternocleidomastoid muscle. CT confirmed this to be a haematoma abscess and at operation it was found to originate from the parapharyngeal vessels, extending from the skull base and tracking inferiorly along the carotid sheath, compressing (and partially thrombosing) the internal jugular vein (IJV). After surgical decompression, double-dose low molecular weight heparin and antibiotics, the patient made an uneventful recovery, including recanalisation of his IJV. Delayed cervical haematoma can result in neck space infection and potential airway compromise. Early CT scanning optimises timely intervention, consisting of airway protection, broad-spectrum antibiotics and surgical drainage.