Fragments of otospongiotic and otosclerotic footplates were investigated by immunohistochemical methods. Antibodies IgG, IgA, IgM were found to be found to the vascular connective tissue of the resorption lacunae, IgG also to osteocytes. The application of antibodies against mumps, measles and rubella antigens showed the expression of the relevant viral antigens in the large cells of the resorption lacunae, in the vascular connective tissue, and in osteocytes, osteoclasts and chondrocytes, present in or around the otospongiotic areas. In the sclerotic stage only the perivascular connective tissue and chondrocytes have expressed viral antigens whereas IgG was restricted to the osteocytes of the sclerotic focus and to the residual perivascular tissue. Two footplates with postinflammatory sclerosis serving as controls revelaed only IgG in some chondrocytes. Healthy footplates showed neither a deposition of antibodies nor any expression of viral antigens. These results favour a viral aetiology of otosclerosis as an inflammatory vasclar reaction of the otic capsule initiated or caused by the viruses of measles, rubella and mumps.

Two cases are presented, both patients with advanced maligant otitis externa.

The antibiotic ciprofloxacin has strong anti-pseudomonal activity. It was given orally for six months to both patients, following administration of the traditional parenteral antibiotic courses, and in each case the disease has been extinguished. We therefore recommend that the management of patients shown to have malignant otitis externa should include strict diabetic control, regular local aural toilet, gentamicin ear drops and a six week course of parenteral antipseudomonal antibiotic agents (usually gentamicin and azlocillin) together with metronidazole to cover any anaerobic element in the infection. This regimen should be followed by a six month course of oral ciprofloxacin (750 mg b. d.). Indium scans should be used to monitor recovery. We believe that this regimen can significantly reduce the morbidity and mortality of patients suffering from malignant otitis externa with cranial nerve involvement.

The incidence of both lateral and cavernous sinus thrombophlebitis has been significantly reduced in the antibiotic era. Since septic cavernous sinus thrombosis (CST) is mainly a complication of facial abscesses and septic lateral sinus thrombosis (LST) is almost invariably due to chronic otitis media, both conditions are of clinical relevance to the otolaryngologist.

The predominant bacterium in septic CST is Staphylococcus aureus whereas in septic LST the bacteriology is very similar to that found in chronic otitis media. The diagnosis of septic CST can be established in most cases after thorough clinical examination, and contrast computerized tomography (CT) using the coronal projection usually confirms the clinical diagnosis. The signs and clinical course of septic LST are non-specific and the final diagnosis rests upon radiological investigations including CT-scan. The treatment of both conditions consists of broad-spectrum antibiotics, including beta-lactamase resistant penicillin in cases of septic CST. Most cases of septic LST also require surgical intervention.

Two cases oi septic intracranial sinus tiuombosis ate presented. The need for early diagnosis and treatment of this potentially lethal condition is emphasized.

In each of twelve matched pairs of patients undergoing tonsillectomy one patient was vaccinated with Pneumovax®, a pneumococcal polysaccharide antigen, prior to tonsillectomy, the other patient being vaccinated after tonsillectomy. Sera were tested for antibody response to three different pneumococcal types of IgG, IgA andIgM classes. The patients with intact tonsils at vaccination did not develop higher antibody response than did those tonsillectomised prior to vaccination. On the contrary, in the case of pneumococcus type 6A, the IgM antibody response in tonsillectomised patients was significantly higher than that in patients with intact tonsils at vaccination (p = 0.021). Thus, the present study did not support the notion thattonsillectomy affects antibody response against pneumococcal vaccination. The palatine tonsils' role as an immunologically reactive organ is also discussed.

Nasal polyps are a condition of uncertain aetiology but are associated with diseases of the lower respiratory tract, in particular, asthma and cystic fibrosis. Asthma may be mediated by mastcell reactions and the commonest allergen to degranulate mast cells is house dust mite. Mast cells have been shown to be degranulated in nasal polyps. This study looks at thirty-six patients who had nasal polypectomy and of whom fourteen were asthmatic to see if histamine wasreleased from polyp tissue and peripheral blood when they were challenged with antihuman IgE and extracts of house dust mite and mixed grass pollens. These results were compared with skin tests to these allergens. A release of above 15 per cent of the total histamine was considered positive. Eight patients released histamine from polyp tissue but only three patients released histamine with both anti IgE and allergen extracts. The release from blood compared well with positive skin tests (p >0.05 corrected chi square). Although allergy may cause mast cell degranulation in polyp tissue, this study suggests that it is unlikely to be a common cause of nasal polyps.

The SWT was performed on 30 patients with chronic haemolytic streptococcus maxillary sinusitis, and 5 controls with no streptococcus in their nose and throat. Foreign and patient's own organism were used as antigen. The lymphoblastic transformation was higher in control streptococcus free patients than in chronic maxillary sinusitis, more when using foreign than patient's own organism. The failure of cellular immune response as a contributary factor tochronicity of maxillary sinusitis is discussed. The possible value of prepared foreign streptococcus vaccine in prevention and treatment ismentioned.

The physiological factors controlling mucociliary transport are largely unknown. Nasal mucociliary clearance was measuredusing the saccharin test in seven patients who had previously undergone vidian neurectomy for vasomotor rhinitis. Persistent denervation was suggested by impaired tear secretion. The control group consisted of thirty-four patients with vasomotor rhinitis who had not had surgery. There was no significant difference in clearance times between the two groups, suggesting that mucociliary transport is well preservedin the absence of neural control.

Swelling in the parotid region is often the presenting sign of a tumour of salivary gland origin. However, the possibility of disease involving adjacent structures must always be considered. Three cases are presented where pathology of the mandibular ramus presented as swelling in the parotid region. A clinical diagnosis of a parotid tumour was made, parotidectomy scheduled, and in two cases carried out before the correct diagnosis was reached. Difficulties of differential diagnosis are discussed, and imaging techniques reviewed. The value of plain radiographs of the adjacent hard tissues is emphasised. Careful interpretation should be based on a sound understanding of pathology of the jaws.

The parotid gland is added to the list of parenchymal organs, notably the pancreas, in which osteoclast-like cells appear as constituent cells in their neoplasms. The cells' role in the neoplasms is a reactive one or, more rarely, as an integral element in an osteoclast-type giant cell neoplasm or so-called osteoclastoma. Distinctive in histological appearance, the osteoclast-type giant cell neoplasm is a malignant lesion that, to date, has been described only in the pancreas and parotid glands. This report presents examples of each type of giant cell lesion in the parotid gland.

The clinician is almost entirely dependent on the histopathologist to accurately diagnose minor salivary gland tumours, but in some cases the histological interpretation of the specimen is very difficult. Recently it has been demonstrated using immunohistochemical techniques that S-100 protein is present in some salivary gland tissues and its localization has been used as an aid in the differentiation of major salivary gland tumours. To assess its value in the diagnosis of minor salivary gland tumours it was localized in sections from 15 such tumours using both a standard peroxidase-antiperoxidase (PAP) and a newly developed immunogold-silver staining sequence (IGSS) technique. Strong staining for S-100 protein was seen in the nuclei and cytoplasm of the cellular areas and also in the cells in the chondroid and myxoid areas of pleomorphic adenomas. Generally the staining was more intense and widespread with the IGSS method. No staining was observed in any of the other tumour types. We conclude that S-100 protein localization is a valuable aid in the differentiation of minor salivary gland tumours. Furthermore, the IGSS method enables more sensitive ‘reading’ of the staining reaction.

Aspirates were obtained from 142 masses in 120 patients who presented with palpable swellings in the head and neck region. 120 specimens (84.51 per cent) were adequate for diagnostic purposes and the remaining 22 (15.49 per cent) were unsatisfactory. Final diagnosis was based on resection histology in 87 cases and close clinical follow-up in 55 patients. The overall sensitivity and specificity including unsatisfactory aspirates was 81.37 per cent and 93 per cent respectively (if the technically inadequate specimens were deleted 98.81 per cent and 94.44 per cent). In comparison with the final diagnosis typing of malignant tumours was possible in 58.33 per cent. The correct diagnosis was made in 63.89 per cent of benign lesions.

A series of of 24 patients wtih a documented diagnosis of non-Hodgkin's extranodal lymphoma (ENL) involving head and neck sites (excluding the cranial cavity) has been studied. In view of recent advances in the diagnosis of lymphoma, a retrospective histopathological review has been undertaken to place all patients in standardized classifications for morphology (the working formulation) and immunology (Kiel). This resulted in a change of diagnosis from non-Hodgkin's lymphoma in four. The histopathology of these four cases, and the implication of such changed diagnoses are discussed. Of the 20 patients confirmed as having non-Hodgkin's ENL, 16 had primary ENL and four had an ENL focus secondary to disease elsewhere. Three patients in this series had an initial diagnosis made of another malignancy, but histopathological review prior to treatment changed the diagnosis to ENL. Details of presentation, pretreatment evaluation, immunohistochemistry, treatment and course have been analysed. The principal treatment policy for primary ENL has been radiotherapy. Of the 12 patients who received this treatment ten achieved a complete response (83 per cent). Eight remain free of disease at the time of writing. The role of adjuvant chemotherapy is also considered.

Laryngeal cysts from 72 patients were examined and reclassified according to a modified working classification. In this series, 47 patients (66 per cent) had epithelial cysts, 11 patients (15 per cent) oncocytic cysts and 14 patients (19 per cent) tonsillar cysts. Epithelial cysts were commonest in the region of the epiglottis (20/47) and laryngeal ventricle (24/47). Oncocytic cysts tended to lie in the region of the ventricle whereas tonsillar cysts occurred almost exclusively in the valleculae, epiglottis and pyriform region (13/14).

The authors conclude that the modified working classification of laryngeal cysts is easy to apply, of clinical relevance, and allows classification of cysts where operative trauma to the specimen obscures the relationship of the cyst to the surface epithelium. The origin and significance of tonsillar cysts are discussed and a relationship to the lympho-epithelial cyst of the oral cavity is suggested.

The natural course of basal cell carcinoma of the middle ear is described. This tumour is extremely rarely found in the middle ear and only two cases have been reported to date. The appearance of the tumour was heralded by earache and deafness, followed years later by wide local destruction of the temporal and parietal bones, base of skull, facial palsy and multiple distant metastases.

The patient refused both surgical and irradiation therapy and died 10 years after the initial diagnosis.

Benign papillary endothelial hyperplasia is a very rare lesion of the nasal cavity; histologically, it may be mistaken for an angiosarcoma. An awareness of this and the ways in which it differs from angiosarcoma will prevent incorrect diagnosis and inappropriate treatment by surgery or radiotherapy. A case report of each condition involving the nasal cavity is presented.