Objective: To evaluate the overall risk of conversion from unilateral to bilateral Méniere's disease (MD), the time interval from initial diagnosis to conversion, and any risk factors or audiometric trends associated with this process. Databases Reviewed: Medline, Embase, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.Gov. Methods: This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting longitudinal progression of unilateral to bilateral MD were included. Random-effects meta-analyses were performed to evaluate the proportion of cases that converted and the mean time to conversion, and a narrative synthesis described risk factors and audiometric data. Results: A total of 11 studies met the inclusion criteria. For overall conversion risk, meta-analysis of the 9 relevant studies (n = 1583) yielded a risk of 13% (95% CI, 12–15%). Mean time to conversion was 8.2 years (95% CI, 5.9–10.6; I ² = 46%), and a combined Kaplan-Meier analysis revealed a prolonged distribution of conversions including 10% that converted 20 years or later after initial diagnosis. Risk factors and audiometric data were sparsely reported, but there may be a correlation between conversion risk and first-sided ear surgery (protective), history of tympanic membrane perforation, and baseline hearing loss in the unaffected ear. Conclusion: There is a significant risk of conversion from unilateral to bilateral MD that must be taken into account when considering ablative treatment options, even late into its course. Further work will be required to better characterize risk/protective factors and audiometric trends.

Objective: Tonic tensor tympani syndrome is found in a subset of tinnitus patients who experience intra-aural and peri-aural symptoms, in addition to their tinnitus, in the absence of clinically detectable pathology. As the syndrome has not been widely reported, this study aims to determine its prevalence and evaluate the effectiveness of current management.Methods: The tinnitus management clinic records of patients over the past six years were assessed to identify tonic tensor tympani syndrome patients and track their progress based on patient-reported Tinnitus Handicap Index scores. Patients with reversible ear pathology and temporomandibular joint disorder were excluded.Results: It was found that 13 per cent of the tinnitus management patients fulfilled the criteria for tonic tensor tympani syndrome and 94 per cent of those who returned for follow up showed an improvement in their Tinnitus Handicap Index grades.Conclusion: This study suggests that tonic tensor tympani syndrome is a significant problem among tinnitus patients and current tinnitus management strategies contribute effectively to helping such patients habituate to their symptoms.

There is a lack of literature studying the impact of various middle ear packing materials on the outcomes of myringoplasty. Absorbable gelatin sponge is commonly used, though it has been reported to induce middle ear fibrosis or adhesions. Chitosan-based sponge has useful properties including hemostasis, anti-adhesion and antimicrobial activity, potentially making it useful for supporting the graft in myringoplasty. This study compares graft success when chitosan and gelatin are used as packing materials for endoscopic myringoplasty. An audit was performed of all patients who underwent endoscopic myringoplasty for chronic suppurative otitis media under the Otolaryngology department of Ng Teng Fong General Hospital between June 2021 and March 2024. Patients were followed up at least 3 months after surgery. Graft success was defined as the presence of an intact graft without perforation at the end of 3 months. 91 patients were analyzed. Gelatin and chitosan were used in 40 and 51 patients respectively. The overall graft success rate of the 91 cases was 79.1 %(n = 72). Tragal perichondrium was most commonly used(46.1 %, n = 42/91), with a success rate of 80.9 %(n = 34/42). The differences in graft success rates among the various graft types and across perforation sizes were not statistically significant.(p = 0.129 and p = 0.399 respectively) There was no significant difference in the success rate between the chitosan group(80.4 %, n = 41/51) and the gelatin group(77.5 %, n = 31/40).(p = 0.736). Chitosan-based packing affords at least equivalent success when compared to gelatin-based packing for endoscopic myringoplasty. It should be considered as a competitive alternative given its other benefits.

Osteomas of the internal auditory canal (IAC) are rare pathologies and diagnosis requires thin-slice computed tomography imaging of the skull or magnetic resonance imaging. We report a case of bilateral florid osteomas in the IAC resulting in tinnitus and vertigo. A literature review identified 29 publications, the majority case reports, meeting our criteria involving 40 patients. We examined symptomatology, laterality, diagnostic imaging, and management strategies. Regarding diagnosis, our findings affirm the importance of thorough clinical and radiological investigations. Of utmost importance, is the assessment of patient symptoms on an individual basis to determine treatment goals, as both conservative and surgical management options have risks and benefits. While conservative treatment remains appropriate for the majority of patients, those with more severe symptoms do experience benefit from a surgical strategy. Careful case selection and management of patient expectations continue to feature as a mainstay of successful treatment. This report aims to contribute to the growing body of literature on osteomas of the IAC and ultimately guide the establishment of evidence-based nationally recognized guidelines to improve care and outcomes in patients with this rare condition.