Laryngeal trauma is an uncommon injury. This has made it difficult for a common management pathway to evolve and controversies remain. Methods of airway control, usage of investigations and the role of stents or plates in surgical management are reviewed. It is important not to delay treatment due to the poor voice and airway outcome of chronic laryngeal stenosis.

This study seeks to define the most appropriate guidelines for selection of patients for magnetic resonance imaging (MRI) to exclude a vestibular schwannoma. Improved selection may reduce patient anxiety and improve resource utilization.

All MRIs of the internal auditory meatus, performed during the year 2000, were reviewed. Audiograms and symptoms were collated for all ’positive’ scans and 100 negative scans. Information was analysed using seven published protocols and other defined frequency specific criteria.

A diagnosis of vestibular schwannoma was made on 36 scans. Four criteria had a sensitivity of >95 per cent; of these the highest specificity (49 per cent) utilized an interaural difference at two adjacent frequencies of 15.dB in unilateral hearing loss and 20.dB in bilateral asymmetric loss.

Applying our best protocol would have reduced the number of scans performed from 392 to 168. The one patient with a vestibular schwannoma who was excluded had trigeminal paraesthesia, an independent indication for investigation.

The ’Bondy operation’, or modified Bondy radical mastoidectomy, consists of a modification of the radical procedure by which the mastoid and epitympanum are exteriorized with preservation of the pars tensa and ossicular chain.

In the 10-year period from 1986 to 1996, 53 patients of the ENT Department of the University of Pisa underwent a modified Bondy radical mastoidectomy, performed with a personalized procedure; 45 of them had a follow up of at least five years.

After the surgical operation, the ears were free of complications in 38 cases (84.5 per cent), while in the other seven cases residual cholesteatoma (one case), tympanic retraction (four cases) or recurrent otorrhoea and phlogosis (two cases) were observed. The post-operative hearing level was unchanged or improved in 41 patients (91 per cent) (33 subjects had an unchanged gap and eight an improved gap), and only in the remaining four cases was the gap made worse. Based on our experience, the modified Bondy radical mastoidectomy is an extremely effective operation with a clear place in modern ENT surgery. When performed on carefully selected patients, it has been proven to offer good functional and anatomical results.

The cytokine, fibroblast growth factor (FGF) and its receptors (FGFR) have a pivotal role in wound repair and have been demonstrated in the perimatrix of active cholesteatoma. Aural polyps are a recognized inflammatory reaction of middle-ear mucosa to cholesteatoma, but may arise in its absence. This study examines 28 archival aural polyp specimens, seeking an increased expression for FGFR1 and FGFR3 in polyps associated with cholesteatoma, when compared with those arising in non-cholesteatomatous, mucosal disease, but produced a null result. There was no difference demonstrated in staining intensity between those polyps associated with cholesteatoma and those without. There was a strong correlation between staining patterns of FGFR1 and FGFR3 (r = 0.4, p <0.03). The expression pattern, of nuclear and perinuclear localization, may support the view that nuclear translocation of growth factors, and their receptors, could be related to the cellular proliferation that is associated with cholesteatoma.

The objective of this study was to prove ciliary destruction in the middle-ear mucous membrane in cases of chronic suppurative otitis media (CSOM) and to compare both types of chronic suppurative otitis media with regard to the degree of ciliary destruction and ciliary count using objective quantitative techniques.

The mucosa of the anterior mesotympanum over the promontory was sampled in 10 patients with mucosal CSOM and in another 10 patients with squamous type CSOM. Specimens were examined by scanning electron microscopy in combination with image analysis software techniques in order to study the cilia under higher magnifications and to calculate the ciliary area. Five patients with otosclerosis, no history suggestive of otitis media and normal ear drum appearance served as controls.

Samples were taken and studied at the Faculty of Medicine of Cairo University.

CSOM was found to be associated with significant ciliary destruction and this was more evident in the squamous type than in the mucosal type.

This paper assessed 300 surfboard riders, comprising 229 males and 71 females to determine the prevalence and rate of growth of exostoses in this population. A group of cold water swimmers and a control group were also examined.

Significant obstruction, defined as two thirds or more occlusion of the ear canal was noted in 90 of the male surfers and 10 female surfers. This degree of occlusion was found in seven of the 32 cold water swimmers.

A male surfer who has surfed regularly for 20 years or more has a one in two chance of developing significant obstruction of the external ear canal resulting from exostoses and this is a three in seven chance for females.

This study evaluated the efficacy of the modified endoscopic Lothrop procedure (MELP) for complicated frontal mucoceles and endoscopic marsupialization for other paranasal sinus mucoceles.

It was a retrospective, consecutive case review of sinus mucoceles treated endoscopically by a single surgeon over a four-year period (1998-2002).

There were 41 mucoceles in 28 patients, including 24 frontal, eight frontoethmoidal, three ethmoidal, five maxillary and one frontal mucocele. Twenty-one patients underwent the modified Lothrop procedure for frontal mucoceles, and seven underwent simple drainage and marsupialization for frontoethmoidal, ethmoidal and maxillary mucoceles. At median follow-up of 16 months, all patients had a patent mucocele opening. Patients treated by drainage and marsupialization did not have any complications or mucocele recurrence. All patients treated by the modified endoscopic Lothrop procedure had improvement in symptoms and signs. Four patients had minor complications including epistaxis and adhesions and five required further surgery. The average hospital in-patient stay was 2 ± 1.4 days.

Endoscopic techniques, including MELP are effective in the short term for the management of complex and simple paranasal sinus mucoceles. MELP has a useful place in the management of mucoceles with a significant bony partition from an adjacent sinus or nasal cavity. It is also indicated when the mucocele is associated with loss of lateral support in the sinus with risk of medial-wall collapse of the orbital contents obstructing drainage.

A postal survey was undertaken to assess otolaryngologists’ awareness, implementation and perceived weaknesses of the Scottish Intercollegiate Guidelines Network (SIGN) clinical guideline for the Management of Sore Throat and Indications for Tonsillectomy. The reply rate was 77 per cent. There was high awareness of the guideline and while 84 per cent of the correspondents felt that they followed the guideline, or a guideline based on it, only 35 per cent were able to accurately recall the four main criteria recommended for listing for tonsillectomy. Twenty-five per cent of the surgeons were in departments that had ongoing implementation programmes for these guidelines but only 10 per cent of surgeons were in departments that had audited their compliance. The most common criticism of the guideline (22 per cent) was that it failed to consider the impact of the disease process on the patient’s quality of life. Suggestions made to improve the guideline are included.

Two hundred and four cases of in-patient admission with isolated, unilateral peritonsillar abscess over the three-year period 1999–2001 were reviewed retrospectively. One hundred and fifty-one patients had been screened for infectious mononucleosis (IM) using the heterophile antibody screening test. Of these 142 (94 per cent) tested negative and nine (six per cent) positive. There were no IM-typical clinical or haematological signs in any of the IM positive patients to facilitate the prediction of the diagnosis. Due to the comparatively high prevalence of positives, the low cost of screening, the lack of predictive signs and the diversity of potential complications of IM, routine screening in all patients presenting with peritonsillar abscess is recommended.

Anterior rhinoscopy with a Thudicum’s or Killian’s speculum is essential in the assessment and treatment of anterior epistaxis. A simple technique for visualization of the nasal septum is described which enables a two-handed approach to treatment and is achieved with materials readily available in the emergency department.

Cavernous angiomas of the internal auditory canal are rare lesions. The authors present a case of a 29-year-old lady with multiple infratentorial cavernous angiomas, whose sister had previously undergone surgery for a similar supratentorial lesion. She initially presented with an acute brainstem haematoma, secondary to a pontine cavernous angioma. Three years later she developed progressive right-sided sensorineural hearing loss and facial nerve paresis due to an internal auditory canal lesion. This was removed via the translabyrinthine approach and was found to be a cavernous angioma.

This report underlines the multiple and dynamic nature of familial cavernous angiomas, as well as the importance of follow up to determine whether new symptoms are due to the enlargement of known angiomas or the development of new ones. As far as the authors are aware, this is the first report describing a cavernous angioma of the internal auditory canal in the context of familial and multiple infratentorial angiomas.

Packing of the nose with a suitable material remains a popular method of treating epistaxis. The authors report a serious complication of a new design of nasal pack; Rapid Rhino®, which was swallowed during the treatment of a patient with epistaxis, resulting in bowel perforation.

Sebaceous carcinoma of the nose is rare. Here the authors present a case of a 71-year-old man who presented with a mass in the right nasal vestibule. This was removed and a nasolabial flap used to reconstruct the defect. Histology revealed a sebaceous carcinoma. At follow-up, three months later, a new lesion had appeared in the opposite nostril which when removed proved to be a second sebaceous carcinoma. This multi-focal presentation in the nose has not been described in the literature before.

This is a case report of a child presenting with a left-sided facial swelling with a perimaxillary infratemporal fossa abscess and maxillary sinusitis of the same side. The patient was treated by incision and drainage via a sublabial approach.

The diagnosis of fungal laryngitis is often overlooked in systemically immunocompetent patients because it is commonly considered a disease of the immunocompromised, and because it often mimics, clinically and histologically, more common and more serious conditions e.g. leukoplakia. A high index of suspicion is required to make the diagnosis, and should be considered in any immunocompetent patient with persistent or refractory laryngitis and factors predisposing to local mucosal barrier impairment e.g. gastropharyngeal reflux, smoking or inhaled steroid use. In such cases, demonstration of hyperkeratosis, particularly if associated with intraepithelial neutrophils, on biopsy should trigger a search for fungal elements using specialized stains. Prolonged treatment by systemic antimycotics is required. Treatment should also include the elimination of any predisposing factors, as failure to do so may result in difficulty with disease eradication or recurrence of the condition.

Hyalinizing clear cell carcinoma (HCCC) of the salivary gland is new disease only recognized in recent years. It is rare and the standard treatment is still under investigation. This is a report of a 42-year-old female with HCCC who presented with a painless submucosal hard palatal mass of three years duration. Wide excision of the tumour and the underlying palatal and maxillary bones was performed. Pathological examination revealed typical clear cells arranged in anastomosing trabeculae, cords, nests, or solid sheets with a hyalinizing stroma. These clear cells were positive for the periodic acid-Schiff (PAS) reaction but were negative for the mucin stain. Immunohistochemically, these neoplastic cells were positive for cytokeratin, but negative for actin. No recurrence nor distant metastasis was found during the eight-month follow-up period.

Sarcoidosis is a multi-system, non-caseating granulomatous disease of unknown aetiology that may affect any organ. The oral involvement of sarcoidosis is rare and usually an initial manifestation of the disease. In this case report the authors present a 25-year-old African-American woman with palatal sarcoidosis treated successfully with intra-lesional corticosteroid injections.

The oral manifestationsof sarcoidosis are relatively uncommon and may be the only manifestation of the disease. Suspected cases of oral sarcoidosis should be biopsied and subsequently referred to a physician to rule out systemic involvement.

Temporal lobe abscess as a complication of parotid abscess is not described in the English literature. In this case report a 66-year-old gentleman is described who presented with a left-sided parotid abscess, which extended to other deep neck spaces, and advanced to develop a temporal lobe abscess and subdural parietal empyema. Treatment included intravenous antibiotics, incision and drainage of parotid abscess, and burr hole aspiration of the temporal lobe abscess. The importance of imaging to evaluate the extent of deep neck abscess and brain abscess is highlighted in this report.