Background: Reconstruction of the stapes superstructure continues to be a problem for otologists. Optimal fixation of implants on the stapes footplate has not yet been achieved. Methods: We postulated that bony fixation, between implant and stapes, could be confined exclusively to the footplate region by modifying the bioactivity of the implant material. Therefore, after removal of the superstructure in guinea pigs a combined biovitro ceramic implant (Bioverit^® I and Bioverit^® II) was placed on the stapes footplate in 10 guinea pigs. As a control, we employed a group of 6 animels in which the stapes superstructure was removed without placing any implant. Results: After 25 weeks the implants were found to be dislocated laterally. We observed fixation with the wall of the middle ear. In the control group we also found new bone formation and even a bow shaped regeneration of the stapes superstructure. Conclusion: Combined Bioverit^® stapedial implants were found to routinely fix to the middle ear wall of the guinea pig. The guinea pigs’ enormous potential for bone regeneration in the middle ear ossicular chain make this species unsuitable for exploring hypotheses on human middle ear reconstruction.

Functional hearing has been shown to be key in developing speech and language skills. In children with trisomy 21, behavioural and anatomical abnormalities make the diagnosis and intervention technically more challenging. This study demonstrates that in the absence of other otological symptoms, hearing loss can be managed effectively and with the least distress to the children with hearing aids.

This is the first observational study indicating increased prevalence of chronic rhinosinusitis in patients treated with anti-tumour necrosis factor therapy. These clinical findings require investigation in greater depth to clarify the nature of pathologies currently diagnosed and treated as chronic rhinosinusitis.

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DESCRIPTIONA woman aged 61 years presented to a district general hospital with a 5-day history of dysphagia, regurgitation of all liquids and solids and lower sternal pain. She had a background of metastatic lung cancer with brain metastases and had previously received chemotherapy and radiotherapy. She was intermittently confused and had no recollection of ingesting a foreign body. On examination, her oral cavity, oropharynx and neck were unremarkable. Plain chest X-ray revealed a midline opaque foreign body at the level of the clavicular heads in the shape of a single coin (figure 1). A lateral soft tissue neck X-ray revealed, on close inspection, the presence of two foreign bodies and these appeared to be two coins lying on top of one another at the approximate level of T3 (figure 2).The patient was fasted and taken to theatre for a rigid oesophagoscopy. Intraoperatively, two 20 pence coins were removed from the upper oesophagus. The region of foreign body impaction was slightly ulcerated and so the patient was started on oral proton pump inhibitors.Studies have shown that a lateral film is not always obtained in cases of coin ingestion.1 Also, some prevertebral radio-opaque foreign bodies will only be visible on a lateral film.2 Anteroposterior and lateral X-rays allowed for this case to be managed more effectively and safely. Knowing the exact number of coins allowed the surgeon to avoid more risky distal endoscopy at and beyond the area of oesophageal ulceration in a patient with significant comorbidity. Learning points▸ It is good practice to obtain anteroposterior (AP) and lateral X-rays in cases of oesophageal foreign body to allow for more accurate characterisation of the foreign body and better surgical planning; especially in cases of coin ingestion, where it is possible to have perfect radiological alignment of several coins on an AP view. ▸ Without a lateral film, it would be possible to miss a second or multiple coins on plain imaging, as demonstrated in this case. ▸ AP and lateral X-rays in cases of multiple oesophageal coin impactions in high-risk patients allow for a safer endoscopic approach to avoid more distal exploration beyond ulcerated areas in the oesophagus.Contributors BW and PL contributed to the design, writing and revision of this article.Competing interests None declared. Patient consent Obtained.Provenance and peer review Not commissioned; externally peer reviewed.