Meningocoele of the fallopian canal has rarely been reported. This lesion can present with recurrent meningitis and, rarely, with facial weakness. All children with recurrent meningitis should be investigated for skull base defects. Treatment aims to prevent further episodes of meningitis; we recommend that this is best achieved by the technique of subtotal petrosectomy, with obliteration of the middle ear and eustachian tube.

The current incidence of missile injury to the temporal bone (MITB) is very low in the United Kingdom. However, the increasing frequency of firearm violence in Britain suggests a greater risk of occurrence. This, along with the devastating potential sequelae of MITB (facial palsy, dead ear, intracranial damage, major vascular injury and cosmetic disfigurement), requires otolaryngologists to be conversant with all aspects of their management. The risk of major complications is much higher with MITB than with temporal bone injury following blunt trauma, and surgical management is, therefore, much more common. We present one such case, and review the literature outlining the pathogenesis, clinical features, and recommended management.

Introduction: Whilst hearing injuries are not life threatening they may have a profound impact on the victim's ability to understand and interact with the world around them. Noise-induced hearing loss is a common occupational injury and hearing impairment as a consequence of noise and blast exposure remains the most common injury in both war and peace for military personnel. Health and Safety legislation has made an impact and in the future innovative approaches to mitigate against acoustic injury sustained in the work place will be fundamental. For the Armed Forces, noise exposure during conflict is unpredictable. Furthermore, recent events in the UK and elsewhere have highlighted the potential civilian impact of blast injuries on hearing in the acute setting. No well-established protocol for the management of acute, blast-induced hearing injury currently exists. Methods: Narrative review is supported by electronic literature searches of PubMed, Embase and the Cochrane Library. Synthesis of published literature and production of flow charts for the acute setting are part of the Emergency Preparedness, Resilience and Response programme. Results: Whilst there is a lack of high-quality randomised controlled trials, there are a number of studies that may inform our choice of acute management. Animal studies of acute acoustic trauma have shown the potential protective effects of corticosteroids. Human data may be extrapolated from sudden onset sensorineural hearing loss where again there is evidence for the use of corticosteroids. Less certainty exists around the use of other treatments including antioxidants. Intratympanic administration of corticosteroids may be superior to oral administration, particularly in the salvage setting. No evidence exists specifically pertaining to the paediatric population. Conclusion: Prompt identification of any hearing deficit followed by administration of glucocorticoids either orally or via intratympanic preparations is the mainstay of management. Further research is needed to identify the optimum acute management.

Careful observation of the middle-ear fluid characteristics following myringotomy can allow for prompt diagnosis.