There is a need for high-quality prospective controlled trials to determine the most effective management of middle ear myoclonus. The authors describe a treatment algorithm based on the data available and clinical knowledge.

Transcranial electrical stimulation FMEP is a valuable tool for monitoring facial nerve function during resection of vestibular schwannoma. Maintaining a FMEP event-to-baseline ratio of 60% or greater is predictive of satisfactory long-term FN function.

Objectives Surgical repair of a tympanic membrane perforation is a common otologic procedure. However, achieving a successful closure can be challenging, especially if the anterior margin of the tympanic membrane is involved. The aim of this study was to systematically review the literature on evidence published in closure of anterior tympanic membrane perforations. Data Sources The following data sources were searched: Cochrane Central Register of Controlled Trials (1997 to August, 3 2017), MEDLINE (February 1948 to August 3, 2017), and Embase (1975 to August 3, 2017). Data Extraction Two authors independently reviewed titles and abstracts. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. For the purpose of this study, the inclusion criteria were as follows; (1) studies reporting surgical technique for closure of anterior tympanic membrane perforations, (2) primary cases only, (3) articles published in the English language, (4) minimum 6-month follow-up, and (5) recorded pre- and postoperative audiometry. The exclusion criteria were non-English language articles, revision surgery, and no audiometric outcomes. Results On initial search, a total of 181 articles were identified (PubMed, n = 136; Cochrane, n = 28; Embase, n = 17). Based on the criteria, 136 articles were excluded. Full text of 45 articles was reviewed, and a further 24 articles were excluded. A total of 21 articles fulfilled the criteria for study inclusion. Conclusions All published evidence is level 4. High-quality controlled studies are required to determine the most effective method for closure of anterior tympanic membrane perforation.

Allergic rhinitis (AR) and asthma represent a continuum of atopic disease and frequently occur as co-morbid conditions in the same patients. The precise mechanism underlying the inflammatory response in the lower airways of rhinitics is not fully elucidated. The primary objective of our study was to understand and to assess the inflammatory response within the upper and lower airways in patients suffering with both asthma and allergic rhinitis. METHODS: Endobronchial and nasal biopsies were obtained from atopic patients with mild asthma and persistent allergic rhinitis. Single blinded study was carried out between April 2007-July 2008. Coded biopsy specimens were embedded into glycol methacrylate resin for immunohistochemical analysis using monoclonal antibodies directed against specific cell markers including mast cells (AA1), eosinophils (EG2), neutrophils (NOE), lymphocytes (CD3ϩ, CD4ϩ, CD8ϩ). 10 analyzable biopsy specimens were studied. Cells were counted blind, as cells/mm2 both in the epithelium and the submucosal matrix. MannWhitney U-test was used for analyses. P-values of 0.05 were considered to be statistically significant. RESULTS: There was a significant increase in CD4ϩ, CD8ϩ cell counts (pϽ0.05) in lower airway. There were no differences between the two groups in the numbers of neutrophils, mast cells, eosinophils and the CD3ϩ cell counts. CONCLUSIONS: The upper airway had a similar pattern of mast cells, neutrophils and eosinophils to that in the lower airway. The increased CD4ϩ lymphocytes may be important in development and maintenance of allergic disease in the lower airway while the CD8 suggests functional diversity and protective effects in the lower airway.