Malignant tumours of the ear canal and middle ear retain a poor prognosis despite the development of increasingly radical procedures. We report the combined experience of 61 patients presenting to our hospital over the past 30 years with this condition. Radiotherapy was the preferred initial treatment in almost all patients. Early surgical treatment by local resection just before or just after radiotherapy and radical mastoidectomy produced disease free survival for two to 20 years in 59 per cent (16 of 27) patients. Long term survival was achieved in 50 per cent of patients with carcinoma of the external auditory meatus and only 24 per cent of those with middle ear carcinoma. Salvage surgery produced a variable degree and duration of palliation but few survivors. Little was gained in the quality of life by petrosectomy.

A postal questionnaire revealed the widest possible spectrum of opinion regarding tympanometry. The reasons are discussed.

This study presents the results of a 20 year review of maxillary sinus wash-outs performed on children. The results show a decreasing incidence of purulent sinusitis over the study period.

Only 17 per cent of antral wash-outs undertaken yielded pus, indicating that surgical practice has failed to adequately take account of the changing disease incidence.

A sublabial incision with septal transfixion and mid-face degloving is described as an approach to the nasal cavity, paranasal sinuses and nasopharynx. A brief history of the development of the technique is given. The results of nine cases are presented. These cases have had good tumour clearance, excellent cosmetic results and the minimum of complications. The sublabial approach is most useful in children and women, particularly those with intermediate grade tumours. The advantages of the approach compared to the lateral rhinotomy incision include: superior access to the floor of the nose, inferior turbinate and anterior nasal septum; access to both sides of the nasal septum and the absence of a facial scar. The limitations of the sublabial technique are the poor access to frontal sinus and the cribriform plate.

A new material, the wax paper enveloping the Fucidin® gauze which is routinely used to pack the nose post-operatively, was utilized in 120 cases considered as ‘high-risk’ for the formation of post-operative nasal adhesions. This proved to be an inexpensive, simple and effective method when the prevention of the formation of nasal adhesions was the primary goal.

The pre-and post-operative ophthalmic consequences of fronto-ethmoidal mucocoeles are considered in a prospective series of 22 patients. Proptosis, lateral and inferior displacement, diplopia and restriction of ocular mobility were the commonest presenting problems. Following external fronto-ethmoidectomy, proptosis and displacement resolved completely in the majority of patients. One third of patients experienced a transient exacerbation of diplopia but this resolved in most patients. Persistent diplopia occurred in seven patients and required medical correction in four and surgery in one. This was due in all cases to underaction of the superior oblique muscle and probably to backward displacement of the trochlea which may be avoided by careful surgical re-attachment.

The role of the otorhinolaryngologist in trans-septal trans-sphenoidal approach to hypophysectomy when undertaken conjointly with the neurosurgeon is to provide excellent and rapid exposure for the necessary neurosurgical manipulation.

For the past two years at the King Fahd Hospital of the University in Al-Khobar, Saudi Arabia, a modified incision for the trans-septal trans-sphenoidal approach to the skull base around the area of the sella turcica has been undertaken in eight cases. This incision may offer a good alternative to the standard hemi-transfixation incision.

Treatment of the paralyzed face remains a challenging surgical problem. When facial nerve damage is irreparable or facial nerve grafting has failed, static and dynamic techniques must be considered. A two-staged modification of the dynamic muscle transfer using ipsilateral temporalis muscle is described. Initially, a free temporalis fascia graft, harvested from the contralateral scalp, is placed around the oral commissure of the paralyzed side of the face through an incision in the nasolabial crease. Several weeks later, an ipsilateral temporalis muscle and fascia transfer is made to the anterior face and attached to the previously placed fascia graft. Oral commissure grafting, as a first step, provides for a secure anchoring point for the temporalis flap, and achieves a more satisfactory correction of the oral commissure.

A clinicopathological study of 51 cases of adenoid cystic carcinoma in the head and neck region seen over a period of 20 years is presented. The correlation between various histological features and their impact on the results is attempted. Longterm results with respect to loco-regional recurrences, distant metastases and survival with various modalities of therapy are presented. Although this is a small series, radical surgery in keeping with the aim of avoiding undue mutilation, thus preserving the quality of life, followed by a full course of radiotherapy has been the mainstay of treatment and the results here presented justify this approach.

Abstract The authors report 18 patients who presented to the ENT department with isolated cough, which had begun one month to 14 years previously. As the ENT examination was negative, the patients were referred to the Department of General Medicine where a bronchial reactivity test with acetylcholine was found to be positive, leading to a diagnosis of airway hyperreactivity. The group was predominantly female (15/18) and atopy was rare; indeed, only one patient, who had a history of allergic rhinitis, was found to be atopic. Bronchodilators and inhaled steroids cured or helped the cough in 16/18 patients. When a patient presents with chronic cough without other respiratory symptoms it is important to consider a diagnosis of airway hyperreactivity and to confirm this with a challenge test of bronchoconstriction

Osteoma of external auditory canal is a rare benign tumour. Usually it is found incidentally and often symptomless. Here we have a case of osteoma arising from the anterior wall of the bony external auditory canal, causing ipsilateral temporal headache which was relieved by removal of tumour

Facial nerve palsy is a known complication of acute suppurative otitis media. Cases of facial nerve palsy following secretory otitis media have not been reported in the world literature. We report a case of bilateral facial nerve palsy following secretory otitis media.

Fibrosarcoma may involve the ethmoid sinus by extension from the maxillary antrum or, more rarely arise as a primary neoplasm.

A case of a well differentiated primary fibrosarcoma of the ethmoid sinuses is reported which presented in a 24-year-old male. The tumour was treated by wide local resection. From a review of similar cases in the literature together with their treatment modalities and outcome. It is concluded that wide local resection is the treatment of choice.

Reported is a child who at the age of 18 months had presented with a left retinoblastoma. The lesion had involved the optic nerve (Stage IV), and was successfully treated by enucleation and radiotherapy. The radiation field did not include the mandible or the submandibular triangle. He was followed up until he left the area aged 11 years. He represented aged 12 years with a progressive swelling of the left submandibular gland. Histology of the surgically excised submandibular gland revealed a mucoepidermoid carcinoma of the submandibular gland. This case highlights the need for continual surveillance in survivors of retinoblastoma, as second primary tumours occur both within and outside of previous radiation fields. The clinical association between retinoblastoma and mucoepidermoid carcinoma of the submandibular gland has not been previously reported.

Tumours of the laryngeal ventricle and saccule are rare and difficult to diagnose endoscopically. We present a case in which the tumour remained confined within the saccule, and describe how the problem of obtaining a positive biopsy was overcome.

The condition of carcinoma arising in a pharyngeal pouch is rare. It has been described in relation to long standing pouches and in pouches previously treated by the Dohlman's operation. Three additional cases of carcinoma of the pharyngeal pouch are described.

Botulinum toxin injection is now recognized as an effective treatment for spasmodic torticollis. Complications of this increasingly popular method of treatment include mild and transient dysphagia, with or without dysphonia, lasting up to four weeks. Two cases of paralysis of vocal cord contralateral to the injected sternomastoid have also been reported. A case of severe dysphagia lasting six weeks associated with ipsilateral vocal cord palsy following botulinum toxin injection is presented. The probable mechanism for these complications is discussed.

Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane. On rare occasions, a thyroglossal duct cyst can present with more sinister symptoms, such as hoarseness, dysphagia and dyspnoea. On these occasions, the pre-operative clinical and investigative diagnosis remains in doubt until histology is available.

An extremely rare case of intravagal parathyroid adenoma is presented. The tumour caused fusiform swelling of the left vagus nerve was shelled out. Post-operatively the left recurrent nerve palsy was recovered in the two months. Serum calcium level returned to normal on the tenth day after the surgical operation without symptoms of hypocalcaemia.

Total or segmental agenesis of the internal carotid artery is a rare anomaly. The cervical portion of the internal carotid artery was absent in the right side of the patient who was carried out radical surgery due to recurrent oropharyngeal cancer. Post-operative venous digital subtraction angiography revealed that the remaining intracranial portion of the internal carotid artery was normally patent and supplied blood flow via ipsilateral external carotid artery. Otolaryngologist-Head and Neck surgeon should know such a vascular anomaly and avoid a disastrous result on dividing external carotid artery.