Holiday review. How random is the toss of a coin?

BACKGROUND: The toss of a coin has been a method used to determine random outcomes for centuries. It is still used in some research studies as a method of randomization, although it has largely been discredited as a valid randomization method. We sought to provide evidence that the toss of a coin can be manipulated. METHODS: We performed a prospective experiment involving otolaryngology residents in Vancouver, Canada. The main outcome was the proportion of "heads" coin tosses achieved (out of 300 attempts) by each participant. Each of the participants attempted to flip the coin so as to achieve a heads result. RESULTS: All participants achieved more heads than tails results, with 7 of the 13 participants having significantly more heads results (p

Chorda tympani nerve function after middle ear surgery.

OBJECTIVE: To assess chorda tympani nerve function before and after different types of middle ear surgery. The hypothesis was that in cases with cholesteatoma, iatrogenic injury to the nerve results in less postoperative taste disturbance than those undergoing myringoplasty or stapedectomy. STUDY DESIGN: Prospective questionnaire study. SETTING: ENT Department of a district general hospital in England. PATIENTS: Adult patients undergoing middle ear surgery in which there would be elevation of the anulus. MAIN OUTCOME MEASURE: Patients' change in taste sensation after surgery with follow-up to demonstrate subsequent recovery. RESULTS: A significantly higher incidence of taste disturbance follows myringoplasty and stapedectomy than for procedures in which the initial diagnosis was cholesteatoma, regardless of the extent of injury sustained by the nerve. The most common complaint after chorda tympani nerve injury is of a metallic taste sensation. CONCLUSION: Despite the small patient cohort, the results support the hypothesis that iatrogenic chorda tympani nerve injury in surgery for cholesteatoma results in less postoperative taste disturbance than that for otosclerosis. This may be because the disease process of cholesteatoma renders the nerve hypofunctional. The situation after myringoplasty is less clear. A larger study may help validate these findings.

Primary middle ear Epstein-Barr virus-related lymphoepithelial carcinoma: case reports and systematic review.

OBJECTIVES/HYPOTHESIS: To report two cases of primary lymphoepithelial carcinoma in the middle ear and to determine the optimal treatment for such lesions. STUDY DESIGN/METHODS: Case reports and a systematic review of the literature. RESULTS: Primary lymphoepithelial carcinoma in the middle ear is an exceptionally rare condition with only two other cases reported in the literature. There appears to be an association with Epstein-Barr virus infection and in those patients originating from the Guangdong province of China, much as is the case for similar lesions found in the nasopharynx. Piecemeal rather than en bloc excision, in combination with adjuvant radiotherapy, appears to adequately control the disease. CONCLUSIONS: Primary lymphoepithelial carcinoma of the middle ear is a rare lesion, which when treated has a good prognosis.

The shelf life of antimicrobial ear drops.

OBJECTIVES/HYPOTHESIS: The advice given to patients regarding the shelf life of antimicrobial ear drops is based on little or no evidence. We aimed to determine appropriate recommendations for the shelf life of common antibiotic-containing topical otic solutions. STUDY DESIGN: Prospective experimental design. METHODS: Ear drops containing gentamicin and ciprofloxacin were analyzed. Their effectiveness was assessed on agar plates inoculated with both Staphylococcus aureus and Pseudomonas aeruginosa. Bottles were also assessed for contamination once opened. In addition, drops used for 1 week on patients with culture-positive otorrhea were analyzed for contamination of both the bottle teat and the drop solution. RESULTS: Neither antibiotic showed deterioration in effectiveness against either microorganism over a 4-month period, as assessed by the size of inhibitory zones on inoculated agar plates. Of drops returned after use on infected patients, none of the cultures from the teats of the bottle grew any organisms. The drop solution itself also showed no contamination after having been opened for 4 months and used by a patient. CONCLUSIONS: There appears to be no evidence that antimicrobial ear drops containing either gentamicin or ciprofloxacin lose their efficacy against either S. aureus or P. aeruginosa over at least 4 months from opening, or that the bottle contents become contaminated after use in patients with culture-positive otorrhea. It is likely these findings apply to other antimicrobial drops and for other organisms. This allows us to advise patients to keep unfinished drops for potential future use with beneficial economic implications.

Central or atypical skull base osteomyelitis: diagnosis and treatment.

OBJECTIVE: We report cases of central or atypical skull base osteomyelitis and review issues related to the diagnosis and treatment. METHODS: The four cases presented, which were drawn from the Oxford, United Kingdom, skull base pathology database, had a diagnosis of central skull base osteomyelitis. RESULTS: Four cases are presented in which central skull base osteomyelitis was diagnosed. Contrary to malignant otitis externa, our cases were not preceded by immediate external infections and had normal external ear examinations. They presented with headache and a variety of cranial neuropathies. Imaging demonstrated bone destruction, and subsequent microbiological analysis diagnosed infection and prompted prolonged antibiotic treatment. CONCLUSION: We concluded that in the diabetic or immunocompromised patient, a scenario of headache, cranial neuropathy, and bony destruction on imaging should raise the possibility of skull base osteomyelitis, even in the absence of an obvious infective source. The primary goal should still be to exclude an underlying malignant cause.