Intended for healthcare professionals

Clinical Review Recent advances


BMJ 1999; 319 doi: (Published 23 October 1999) Cite this as: BMJ 1999;319:1110
  1. Aurelia Richards, specialist registrar in otolaryngology,
  2. Michael Gleeson, professor of otolaryngology and skull base surgery (
  1. Department of Otolaryngology and Skull Base Surgery, Guy's Hospital, London SE1 9RT
  1. Correspondence to: M Gleeson

    Life is punctuated with problems arising from the ears, nose, and throat Minor ailments like colds and pharyngitis incapacitate briefly but remind us how wonderful it is to be well. We take for granted the ability to hear, walk straight, smell, breathe freely, speak clearly, sing, and swallow our own saliva easily and without conscious effort Life becomes exceptionally difficult when disease affects these basic functions. Recent advances in otolaryngology have gone some way to addressing a few of these problems, which affect thousands of patients every year and have the potential to destroy the quality of their lives for decades.


    This review has been driven by changes in our clinical practice over the past five years. The chosen topics have been searched through Medline from January 1996 to March 1999 using the key words hearing loss, hearing aid, pharyngeal pouch, functional endoscopic sinus surgery, dacryocystorhinostomy, orbital decompression, and cerebrospinal fluid leak.

    Rehabilitation of hearing loss

    About 8.7 million people are deaf or hard of hearing in the United Kingdom. A third of the population has a significant hearing loss by the time they retire (fig 1). Half of these people could be helped by a simple hearing aid, but despite free NHS aids less than a quarter possess them. More surprisingly, over 80% of octogenarians have conspicuous hearing losses yet only a quarter use hearing aids. Why should this be so? For some, the need to wear a visible appliance is unacceptable even in advanced age, while for others crudely amplified sound, the frustration of whistling from auditory feedback, and irritation caused by occlusion of the ear canal by a mould is more of a hindrance than a help.

    For patients with moderate to severe sensorineural hearing loss a new implantable device became available in Britain last year.1 2 The Vibrant P …

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