Implantable bone conduction aids are potentially an important advance for those with a conductive hearing impairment. One system (Xomed Audiant bone conductor), which uses electromagnetic induction to vibrate a subcutaneous implanted skull magnet, has now been implanted in sufficient patients in the United Kingdom, for enough time, for its indicationsto be evaluated.

Seventeen of the total of 18 patients that have been implanted, satisfied the average threshold criterion for suitability for implantation (average bone conduction over 0.5, 1 and 2 kHz of 25 dB HL or better) yet only 10 of the 17 (59 per cent) currently use their Audiant aid. This was not because of technical reasons but was mainly influenced by the previous type of amplification. Current usage of a body level processor was 100 per cent) (6 of 6) in those that previously could only use a conventional bone conduction aid because of bilateral congenital or acquired atresia of their external auditory canals. In comparison, usage was only 36 per cent (4 of 11) in those that could potentially use a conventional ear level aid albeit with problems such as the discharge from active chronic otitis media. This relative non-use was considered due to a lack of power of the ear level processor and the general unwillingness of patients to change from an ear level to a body level device.

A challenging surgical problem is the correction of supra-tip depression of the nose following collapse of nasal septal support. Numerous materials have been used in augmentation rhinoplasties attempting to correct this deformity, all having certain disadvantages. A modified technique is described in which costal cartilage surrounded by perichondrium is grafted in such noses; the results of a small series is discussed. The problems of graft distortion and resorbtion appear to have been satisfactorily overcome by using this procedure.

A series of 116 young adults with cancer in the head and neck who had been followed up for five years or longer were reviewed. The study aimed to assess whether malignancy in this age group was increasing, whether their prognosis was worse and if so, why. They were compared with data available on the patient population as a whole treated during the same period. This demonstrated that it is the intrinsic characteristics of the tumour, its site and extent rather than the age of the individual which determines prognosis though the ratio of men to women was less in the young adults in several sites possibly due to a diminished impact of recognized aetiological factors.

The use of diathermy in achieving haemostasis at tonsillectomy was assessed by means of a postal questionnaire sent to consultant otolaryngologists practising in the U.K. A response of 81 per cent was obtained. Forty-four per cent presently use diathermy. Few considered the age of the patient or a history of a quinsy a contraindication to its use. The diathermy experience of users and non-users with regard to speed, postoperative pain and haemorrhage differs markedly. This dichotomy of opinion is confirmed by a review of the literature. Clearly there is a need for further studies to clarify the role of diathermy in tonsillectomy.

There have been many approaches advocated over the years for the surgical management of hypopharyngeal diverticulum, and this is a reflection of the absence of an ideal method both in terms of the surgical technique and of the frequency and severity of complications. Further experience with the use of the surgical staple gun is presented together with a discussion of its use in comparison with other operative methods. The ease and speed of the technique combined with a negligible complication rate suggest that it is a viable method for the management of large diverticula.

Symptoms at first onset and on initial examination were analyzed in 845 patients with maxillary sinus carcinoma. About 20–30 per cent of the patients became aware of swelling of cheek, nasal obstruction, nasal discharge and epistaxis as first symptoms. About 50–80 per cent of the patients complained of such symptoms on initial examination. Symptoms of maxillary sinus carcinoma are similar to those of chronic sinusitis which results in a delay in diagnosis. Such symptoms should be recognized to improve survival rate. CT and MRI scans are useful for early diagnosis and determination of tumour extension. Sinoscopy with biopsy is most important to detect the earliest tumour stage.

A 30-year-old female presented with a ten-year history of bilateral conductive deafness. A pre-operative diagnosis of otosclerosis was made but at tympanotomy, the stapes crura in each ear was found to be disconnected from the foot- plate, the ossicular chain being otherwise normal. A Teflon-wire prosthesis was used to join incus and footplate, with good results. In the absence of a history of trauma or sepsis this may be a late presentation of a congenital stapedial anomaly which has not previously been reported.

Sudden onset sensorineural hearing loss is an otological emergency. Although deafness is recognised as being associated with polyarteritis nodosa (PAN) only very rarely does it herald the disease. We describe a case of bilateral, sudden onset vestibulo-cochlear failure which with thorough investigation proved to be the presenting complaint of PAN.

This diagnosis enabled definitive management of a multi-system disorder and resulted in an improvement of the initial symptom with the chemotherapeutic regime discussed.

We review the involvement of PAN in deafness and hope this case will remind otolaryngologists of the need for full investigation of the above mentioned emergency, in an attempt to discover and hence direct management towards a specific underlying pathology.

Auditory brainstem responses are an established technique in the diagnosis of acoustic neuroma. In several reports abnormalities are shown to occur in the contralateral ear.

That these abnormalities recover has been demonstrated, but only in terms of changes in inter-peak latency. In only one case has the waveform trace showing this been published. We present a case in which a highly abnormal wave form was obtained from the ear contralateral to a large acoustic neuroma. Following excision of the lesion, the waveform reverted to a normal pattern. The literature on the subject is reviewed.

Extraskeletal Ewing's sarcoma is rarely found arising in the head and neck region. An unusual case arising in the nasal fossa in a young child is reported and the differential diagnosis, pathology and treatment discussed.

The aim of this paper is to highlight Potts puffy tumour as a pathological entity distinct from other causes of peri- and supraorbital swelling. This uncommon condition is usuallynot recognised initially and is easily confused with neoplasms or local eye pathology. A case is reported and investigations and management reviewed.

The case of an 18-year-old man who presented with a large cystic mass in the floor of the mouth extending into the left submandibular triangle of the neck is reported. Histopathology of this mass, which was totally excised by a combined intra-oral and cervical approach, confirmed it to have originated in ectodermal remnants (congenital dermoid cyst) and to be actively secreting sebum. This case is reported both because dermoids at this site are rare because they may present some problems in management.

Kawasaki disease (mucocutaneous lymph node syndrome) is an acute vasculitis of childhood carrying a 1–2 per cent mortality from cardiovasular complications. Despite the extensive literature on Kawasaki disease in paediatric journals, there has been a paucity of documentation in the otolaryngological literature. This is despite the fact that Kawasaki disease may present as an otolaryngological emergency before the diagnosis is established. We describe three cases of Kawasaki disease, all of which presented to the ENT department of this hospital within a period of two months. These cases illustrate the slow evolution characteristic of the disease and highlight the difficulties of diagnosis in the initial febrile stage. We emphasize the importance of considering the diagnosis when treating a young child with a pyrexia resistant to antibiotics, as prompt introduction of therapy may decrease the risk of fatal coronary artery or cardiac involvement.