Aims: To evaluate parents' satisfaction with medical and allied health services provided to children with Down syndrome in north-west England, comparing ENT and its allied services with other areas of health service provision.

Methods: A questionnaire survey of parents attending a north-west England Down syndrome association conference. Demographic data, departments visited, satisfaction with each service (scored one to five), waiting times for each service (scored one to five), service need (scored one to three) and accessibility (scored one to three) were recorded.

Results: Otolaryngology had been used by 50 per cent of children, with a satisfaction of 2.63 (the second worst score). Speech and language therapy was used by 90 per cent of the children, with a satisfaction of 3.26 (the worst score). The service felt to be most needed and also most difficult to access was speech and language therapy.

Conclusion: Otorhinolaryngology departments should assess how they can improve their service to this population with specific ENT needs. Speech and language services for children with Down syndrome should be expanded.

We present a technique, which has not been previously described in the literature, of using rolled autogenous conchal cartilage for dorsal augmentation via an endonasal or external rhinoplasty approach. This technique gives greater dorsal height compared with the more common layering techniques. It is most appropriate in the minimally or moderately saddled nose.

We describe a series of four patients who presented with ‘high globus pharyngeus’, who all had an abnormally curled epiglottis tip touching and indenting the tongue base. The actual incidence of ‘curling epiglottis’, as well as the potential impact of this variation in persistent globus symptoms, is not known. We therefore describe for the first time a series of patients with this anatomical variant of the epiglottis, each of whom experienced unresolved globus symptoms despite receiving intensive medical treatment. In the literature, the success rate for improvement in symptoms following medical treatment ranges from 68 to 80 per cent.

Following CO2 laser partial epiglottectomy, all four patients experienced complete relief of their symptoms.

We advocate consideration of this treatment for high globus pharyngeus that fails to respond to conservative treatment, in cases with proven curled epiglottis on endoscopic examination.

Following surgery in the USA in 1992 to remove a large right cerebello-pontine angle tumour, a 39-year-old woman developed severe brainstem and cerebellar infarction. This left her with severe visual impairment and ataxia. She became able to communicate by means of an adapted finger-spelling alphabet. She had total hearing loss in the right ear and a mild to moderately severe sensorineural hearing loss in the left ear, and severe tinnitus heard throughout the head. Additionally, she experienced hypersensitivity to sound above normal conversational levels, which evoked a synaesthetic feeling of coldness across her upper torso. Previous linear analogue hearing aid fitting had not been beneficial for either hearing or tinnitus. Careful fitting of a digital hearing aid, together with tinnitus counselling, inhibited the patient's tinnitus to 25 per cent of its former intensity after a six month acclimatisation period, and improved communication.

We report a case of bilateral profound unremitting sensorineural hearing loss, in a 44-year-old male patient occurring after ingestion of sildenafil citrate 50 mg/day for 15 days. Audiological evaluation documented the findings. Sildenafil is an effective oral treatment for erectile dysfunction syndrome. It is being used and abused by many people as availability is easy and it can even be bought over the internet. Many patients are unaware of the harmful effects of sildenafil and take the drug without medical supervision. We could not find any previously reported cases of sildenafil induced hearing loss and to the best of our knowledge, this is the first case report of sildenafil induced sensorineural hearing loss in the world literature.

Madelung's disease is a benign disorder characterized by the presence of lipomata in the head and neck areas. It is disfiguring for the sufferer and is usually asymptomatic. Dysphagia and airway obstruction are rare presentations. Early surgical excision is recommended to exclude sinister pathology and to improve patient function. This is the first report (according to our literature search) of a patient who presented with dysphagia and obstructive sleep apnoea and in whom surgical intervention resulted in an improvement in both these symptoms.

We report the case of a 43-year-old woman who presented with a spontaneous pneumocephalus, 37 years after a mastoidectomy. Clinical examination showed a cerebrospinal fluid leak, meningeal herniation in the superior part of the middle ear, and an audible noise from her ear when she stood up due to the entrance of air into the cranium. A computed tomography scan and magnetic resonance imaging showed the complete destruction of the tegmen tympani and the pneumocephalus in the temporal lobe. The patient underwent an emergency operation via a double middle-ear and subtemporal approach. The meningoencephalocoele and pneumocephalus were probably due to long term pressure upon too thin a tegmen tympani.

Pneumocephalus should be considered as a potential delayed post-operative complication of middle-ear surgery. Computed tomography and magnetic resonance imaging scanning supply accurate information and enable a planned surgical approach; they also allow a pathophysiological understanding and a correlation between the clinical signs and the radiological and peri-operative findings.

We present a rare case of maxillary intraosseous vascular malformation and review the nomenclature used by pathologists and clinicians in classifying vascular anomalies. We also discuss the literature and highlight potential management pitfalls.