The efficacy of a biocompatible, surgically implantable, antimicrobial release system (IARS) as the exclusive antimicrobial therapy of necrotizing external otitis (NEO) was evaluated in six NEO patients. Gentamicin incorporated polymethyl-methacrylate beads were implanted, following surgical debridement and were removed two months later. Post-implantation alleviation of clinical symptoms: pain, periauricular tissue swelling, otorrhoea, eradication of pseudomonal infection (100 per cent) and substantially shortened hospitalization (4–15 days) were the salient results of this therapeutic modality. Three patients recovered. Two patients who died, one of sudden cardiac arrest and the other of paralytic ileus, 15 and 60 days postoperatively while the beads were still implanted, were symptomless. Recurrence was seen in one patient with early bead extrusion. Ipsilateral sensorineural hearing loss (one patient) and external meatal stenosis were the main complications. IARS appears to offer an effective alternative to long-term systemic antibiotic administration for the eradication of NEO-pseudomonal infection in patients who are sensitive, develop resistance, or when quinolone medical treatment has failed or is contra-indicated.

New Zealand Maoris are one of five ethnic groups in developed countries known to have a high rate of ear disease, including perforation of the eardrum (CSOM). It is a strongly held belief by otolaryngologists whose practice dates back to the 1960's that the prevalence of CSOM in Maori children is gradually falling. Despite the obvious practical implications this change has not yet been documented.

The aim of the study was to compare the prevalence of CSOM in two surveys conducted in 1978 and 1987 of children living in a North Island Maori community. A second aim was to examine the natural history of CSOM in these children.

The raw data from the 1978 study were reviewed. Of 134 children aged 4–13,12 had CSOM. In 1987 the same age group yielded 12 children out of 250 with CSOM. The prevalence of CSOM fell from 9 per cent to 4 per cent. The incidence of new perforations in 1987 was 1.3 per cent per child per year. It is concluded there has been a fall in the rate of CSOM, although otitis media remains a significant problem for these children.

The probability of a perforation healing was influenced by whether or not the perforation had been observed before: at least 35 per cent of perforations seen for the first time healed, but none of the perforations seen on two occsaions healed spontaneously. It was concluded that perforation of the eardrum can be managed conservatively at first.

A histopathological study of acquired cholesteatoma in four temporal bones from two adults and one child is presented. The findings suggest that the cholesteatoma originated from the retraction pockets of the tympanic membrane and there was active growth of the squamous epithelium of the retraction pockets, which may be enhanced in the presence of otitis media.

This study compares the histology of aural polyp with the subsequent clinical course of the middle ear disease. AH cases of aural polyps that presented to the department during 1988 and 1989 were included. Patients who had previous ear surgery were excluded as were cases where the operation was part of clearance of known cholesteatoma rather than polypectomy alone.

We found that the histology of the aural polyp was not a precise predictor of the presence or absence of cholesteatoma, nor of the subsequent course of the middle ear disease.

A retrospective series is presented of 51 cases operated on for suspected perilymph fistula. In 26 ears a fistula was identified at surgery. A positive fistula test was found to strongly indicate a perilymph fistula but was more often negative than positive in surgically demonstrated fistula ears. Other vestibular tests were found to be of little value in the pre-operative diagnosis. Ears with a surgically demonstrated fistula and sensorineural hearing loss had either flat or downward-sloping audiograms. Difficulties in diagnosing a perilymph fistula at tympanotomy are discussed. At follow-up, vestibular symptoms were found to be eliminated or improved in 96 per cent of cases with surgically demonstrated fistulae and in 68 per cent of cases in which no fistula was detected at tympanotomy but hearing improved significantly in only one ear (4 per cent) of the former group and in five ears (20 per cent) of the latter group.

A radiological study of skull base anatomy was performed in patients presenting with primary spontaneous CSF rhinorrhoea. Radiology correctly identified the fistula site in 90 per cent of cases. Contrast CT imaging was found to be the most suitable technique for identifying the presence and site of CSF fistulae. However, pre-contrast bony dehiscences were identified in all patients leaking from the cribriform plate region. More significantly, all of these patients showed deviation of their crista galli, a radiological sign hitherto unreported. These findings support the theory that congenital bony dehiscence is the aetiological basis for this condition. The importance of radiology in the management of this condition is emphasized.

Magnetic resonance imaging is able to demonstrate a wide range of sinus abnormalities. Incidental findings in patients referred for neuroradiology because of suspected intracranial pathology are surprisingly common and were present in 37.5 per cent of 483 images examined. The maxillary and ethmoid sinuses were most commonly affected with 27 and 26 per cent of images abnormal whereas the frontal and sphenoid sinuses were less commonly affected with 5 per cent of each abnormal. If minor changes were excluded then 17 per cent of patients had either fluid, a polyp or marked mucosal thickening in at least one sinus. Nasal symptoms, other than the presence of a cold, showed no statistically significant relationship to abnormal findings. Many people with inflammatory changes in their sinuses demonstrated on MRI do not have symptoms classically attributed to sinusitis.

Failure to get relief from topical steroid nasal spray is often blamed on poor administration knowledge. In a population of patients referred to the rhinitis clinic who have failed to get relief from topical steroid nasal spray when prescribed by the general practitioner, lack of patient education only accounts for 28 per cent of patient treatment failures and other factors e.g. poor compliance, erroneous diagnosis or severity of rhinitis will be responsible for the rest. Information leaflets are considered to be a good idea by nearly all patients but this study demonstrates that they would only be of therapeutic benefit to a minority of patients.

A series of 52 patients were closely assessed prospectively to determine the effectiveness, untoward effects and patient acceptance of a new method of treatment of ‘vasomotor rhinitis’ by silver nitrate application. The patient's age ranged from 11 to 50 years except one who was 58 years old. The report describes the technique used and results obtained following the painting of the ‘trigger area’ of the nasal mucosa in patients with ‘vasomotor rhinitis’. Each patient was evaluated regularly and the evaluation was based on both subjective response and clinical examination. Only cases who had rhinorrhoea and sneezing as presenting symptoms were selected. Silver nitrate (20 per cent) was used after topical anaesthesia, and patients received four applications. Successful relief was obtained in 88.5 per cent (53.0 per cent good relief; 34.6 per cent acceptable relief), while 11.5 per cent of the cases (6 out of 52 cases) had poor relief. No complication was seen among the patients during treatment and follow-up and no silver poisoning was detected.

The presence of human papillomavirus (HPV) genomes 6, 11, 16 and 33 in 16 patients with laryngopharyngeal carcinomas was examined by means of a polymerase chain reaction. HPV genomes were detected in 75 per cent of cases. In hypopharyngeal carcinoma, HPV 6 and 11 were present in adjacent tissue but absent from the tumour. HPV 16 and 33 were present in 40 per cent of laryngeal tumours and adjacent tissue. These results suggest that HPV 16 and 33 may be closely associated with the development of some laryngopharyngeal carcinomas.

Reinke's oedema (RO) of the vocal folds is a condition of unknown aetiology. Cigarette smoking and vocal abuse may contribute to its development. Hypo thy roidism has been described as an aetiological factor but, to date, no controlled study has been published confirming this association. This prospective, controlled study compared thyroid function in 61 consecutive RO patients with an age and sex matched control group (n = 65) without laryngeal disease. Thyroid function was assessed by measuring serum thyroid stimulating hormone (TSH), free thyroxine (T4) and tri-iodothyronine (T3). Hypothyroidism was diagnosed when TSH was above normal with a T3 and T4 below the normal range.

Four RO patients were hypothyroid at the time of diagnosis, compared to five of the control group. Six RO patients had past or present hypothyroidism compared to seven of the controls. One RO patient and two controls were euthyroid with marginally elevated TSH levels. Although the incidence of hypothyroidism in this group of Reinke's oedema patients is higher than expected in a normal population, it is similar to that in an age and sex matched control group, reflecting the prevalence of hypothyroidism in middle aged women.

This study suggests that hypothyroidism is not an aetiological factor in the development of Reinke's oedema.

Survival of patients with surgically treated malignancy may be adversely affected by blood transfusion. Immune suppression due to transfusion has been implicated but remains unproven. We conducted a study of 240 patients with squamous cell carcinoma of the larynx undergoing laryngectomy to assess the effect of per-operative blood transfusion on survival.

We report our experience with 199 patients requiring admission with a diagnosis of croup over an 18 month period. The value of using pulse oximetry to monitor these children was critically examined. Twenty-nine patients with clinically significant stridor were monitored for an average of 12 hours. There was poor correlation of clinical status and respiratory rate with hypoxia as shown by the technique, with frequent dips in oxygen saturation being caused by technical problems such as movement artefact. Pulse oximetry is a useful adjunct to the clinical assessment of croup, but cannot be relied upon solely for monitoring these labile patients.

Damage to the nasolacrimal duct during major sinus procedures results in troublesome symptoms of epiphora and acute infection. Prophylactic stenting of the lacrimal apparatus using a silicone stent is described as a means of preventing such complications.

Acanthoma fissuratum secondary to the use of spectacles is a rare clinical finding associated with an ill-fitting frame. An interesting case is presented to highlight such a problem. Surgical excision of such lesions is recommended with advice to the patient regarding the suitable fitting of spectacles.

Keratoacanthomas are lesions which rarely present to Otorhinolaryngologists; however they must be considered in the differential diagnosis of any rapidly growing lesion in the head and neck. We report a case of a keratoacanthoma of the nasal vestibule which caused clinical and histopathological difficulties in diagnosis. Keratoacanthomas and the treatment options are discussed.

We report a case of polymorphous low grade adenocarcinoma involving the palate of a 12-year-old girl, the first example of this tumour occurring in the paediatric age group. The tumour displayed infiltrative growth, neural invasion, variegated histological patterns, and minimal cytological atypia. The patient remained disease-free four years after wide local excision of the tumour. The distinction of polymorphous low grade adenocarcinoma from pleomorphic adenoma and adenoid cystic carcinoma is also discussed.

Stridor due to obstructive causes is relatively common. Functional airway obstruction with paradoxical vocal cord motion is uncommon. Only 12 cases have been reported in the literature in the past 15 years. The majority were young female patients. We have recently encountered two cases. Lack of awareness of this condition caused several problems in management.