At the Kidwai Memorial Institute of Oncology, advanced laryngeal cancers are subjected routinely to primary surgery and/or post-operative radiotherapy (RT). The surgery consists of wide field laryngectomy which entails total laryngectomy, ipsilateral/bilateral thyroid lobectomy, bilateral paratracheal clearance, and bilateral clearance of levels 2, 3 and 4 lymphatics. Post-operative RT is indicated in event of the following histopathological (HPE) situations to consolidate local-regional control: (1) T4 primary; (2) significant subglottic extension; and (3) jugular/paratracheal metastatic deposits. This prospective study highlights the therapeutic efficacy of this protocol at our centre in 45 consecutive T4/T3 glottic cancers and specifically evaluates the role of interjugular dissection and/or post-operative RT in prevention of regional recurrence. Fifty-two per cent of primary lesions needed a post-surgical upstaging as against 14 per cent of the neck lesions. Accordingly 91 per cent of the cases (41/45) qualified for post-operative RT and 82 per cent (37/41) complied with the prescribedschedule. Recurrent disease in the lateral neck was noted in 2/37 who received the prescribed schedule and 1/4 non-compliant cases; while a recurrent central neck disease was noted in 1/37 and 1/4 of these cases respectively. All cases were followed-up for a period of two years and 66 per cent of the evaluable cases for a period of five years. This study confirms conclusively that our treatment schedule yields extremely gratifying two-year local-regional control rates of 89 per cent which translates into a two and five-year actuarial survival rate of 92 and 70 per cent respectively.

During a period of two years, 24 cases of antrochoanal polyps were diagnosed by clinical examination, nasal endoscopy and computerized tomography. Surgery started with endoscopic transnasal removal of the polyp. Every attempt was made to remove the antral portion of the polyp through the wide ostium. Then transcanine sinuscopy was performed. Remnants of the polyp were detected and removed in five cases. One or more other cysts were found and extirpated in 11 cases. Endoscopic follow-up for 18 months to three years revealed no recurrence.

It is recommended that endoscopic middle meatal surgery should be combined with transcanine sinuscopy to ensure complete removal of antrochoanal polyps.

Thecase records and histology of 34 patients with vocal process granulomata were reviewed. The five patients presenting most recently with idiopathic vocal process granulomata were investigated by axial computerized tomography (CT). Increased density of the arytenoid cartilage on the side of the lesion was found in all five cases. It is suggested that this indicates cartilage ossification, secondary to periochondritis. This perichondritis, playing either a primary or a secondary role in granuloma development, may explain the annoying tendency of vocal fold granulomata to recur after excision.

Anatomical and functional estimations of the upper airways in patients after partial laryngectomies (cordectomy, hemilaryngectomy, enlarged hemilaryngectomy) carried out due to cancer are discussed in this paper. The post-operative lumen of the larynx and the trachea were estimated by radiological examination. The coefficient larynx/trachea (L/T) was proposed to describe fixed obstruction.

At the same time, all patients underwent spirometric examinations. Inspiratory and expiratory parameters of the flow-volume loop were evaluated. In 39 patients the L/T coefficient was lower than in a group of patients with chronic bronchitis (P<0.05). Also inspiratory and some expiratory parameters of the flow–volume loop decreased in contrast to the group with chronic bronchitis. All results showed the usefulness of radiological and spirometric methods in detecting upper airway obstructions and confirmed their fixed character. The influence of the area of operation on the degree of upper airway obstruction was emphasized.

Bilateral transnasal vidian neurectomy was performed on 276 patients between 1983 and 1991. The indications for operation were intractable vasomotor rhinitis, resistant allergic rhinitis and recurrent nasal polyposis. Two hundred and fifty-eight patients were contacted and long-term results showed that 88 per cent of the patients had an excellent result.

One of the most common problems following otoplasty is that the bandage applied at the time of surgery slips prematurely, falling over the patient's eyes and thereby requiring replacement.

We present a simple technique which prevents this from occurring.

A reduction in cell adhesiveness and cell invasion are essential steps in tumour progression. In the present study six tongue carcinoma cell lines were compared with regard to their invasive potential in two in vitro invasion assay systems and for their patterns of expression of the cell–cell adhesion molecule E-cadherin. The three cell lines negative for E-cadherin expression were invasive in both assays. One cell line with strong E-cadherin expression was strongly invasive and one weakly invasive. One cell line with reduced E-cadherin expression was weakly invasive. There was no significant pattern to these findings (x2 = 0.375; p = 0.54). This supports previous studies from this group that suggest that E-cadherin is only one of the presumably many molecules involved in tumour progression in squamous cell carcinoma of the tongue.

This paper reports on 13 patients with a pain syndrome arising from the region of the greater cornu of the hyoid bone. It is often missed and yet is readily treatable. The syndrome causes pain on swallowing in the region of the hyoid which may radiate to the ear, face and lower jaw or may be felt also in the pharynx. Treatment by an injection of a mixture of depomedrone and one per cent lignocaine is very effective.

The underlying pathology is discussed and it is suggested that in some cases the pain and discomfort experienced by patients may be due to tenosynovitis of the intermediate tendon of the digastric muscle. Greater recognition of this relatively common condition would not only result in more effective treatment but would also avoid unnecessary investigation and surgery.

We present the case of a 40-year-old male Caucasian patient who developed surgical emphysema of the neck five weeks after surgery for exostoses of the external auditory canal. Imaging of the temporal bone demonstrated that the surgery had resulted in entry into the temporomandibular joint. A mechanism is proposed for this novel complication.

Loss of bony integrity of the temporomandibular joint may result in prolapse of the joint capsule into the external auditory canal. This in turn gives rise to arthralgia, trismus and earache and a risk of septic arthritis.

We describe a technique of repair which is simple, uses autologous tissue and has an acceptable cosmetic and functional result.

The oropharyngeal and nasopharyngeal microbial flora of 40 children with chronically hypertrophied and infected tonsils or adenoids, was studied. Twenty of the children were treated by tonsillectomy and 20 by adenoidectomy. Swabs were taken from the surgical field pre-operatively and from the oropharynx or the nasopharynx 10 and 30 days post-operatively. The swabs were cultured on suitable culture media and identification as well as quantitative estimation of the isolated bacteria, was carried out. Most of the potentially pathogenic bacteria exhibited β-lactamase production.

Interestingly, after surgical treatment, the respective microorganisms were quantitatively reduced and it was observed that their isolation rate was also lower. Furthermore, bacteria considered as normal inhabitants regularly showed an increase in their frequency of isolation despite the fact that a quantitative decrease was in some instances observed. These findings suggest that tonsillectomy and adenoidectomy result in an alteration to the abnormal oropharyngeal and nasopharyngeal microbial flora producing an almost normal one. It appears that, in cases of the failure of antimicrobial treatment, surgical procedures should be seriously considered.

This study was designed to compare the differences in morphology of the mast cells from the adenoid in children with otitis media with effusion (OME) and those from children with recurrent tonsillitis. Tissue for electron microscopy was prepared in the standard manner and between three and 10 blocks were examined for each child. All the mast cells with nuclei were photographed and the condition of the granules noted. The number of electron dense granules in each cell was assessed on a scale between zero and 10. Sixteen unselected children with OME were compared with 19 children with recurrent tonsillitis. There were no obvious differences in the degree of degranulation between the two groups although there was more vacuolation than reviously described in the normal nose but less than in those patients with perennial allergic rhinitis. Allergy and mast cell reactions do not seem to predispose to OME. It was concluded that the adenoids are not the ideal tissue in which to study normal mast cells.

Thirty patients with external laryngeal trauma were analysed retrospectively. Injuries were mostly caused by motor vehicle accidents (car = 36.7 percent; motorcycle = 23.3 per cent). The main presenting symptoms and signs were hoarseness, neck tenderness, dysphagia, and neck emphysema. Sites of laryngeal injury included arytenoid swelling, vocal fold injury, soft tissue contusion or superficial mucosal laceration, cricoarytenoid dislocation, thyroid fracture, epiglottic fracture and mixed injuries. Treatment was varied depending on the severity of the injuries. Sixteen cases were managed conservatively by medical treatment; two cases received intubation; four cases were treated initially by tracheostomy; eight cases received surgical repair and/or reconstruction; 11 cases made a full recovery of the voice and 18 cases fair voice recovery due to either sustained vocal fold swelling or limitation of vocal fold movement. One case was graded as poor. Twenty-eight cases had good airway patency and two cases fair airway patency. A delay in the early detection of laryngeal trauma may precipitate into life-threatening airway problems, therefore prompt and accurate diagnosis should be followed immediately by skilful airway management.

The effective management of paranasal sinus aspergillosis requires early diagnosis, histological classification, surgery and where appropriate, chemotherapy. Fungal sinusitis may be easily missed unless a high index of suspicion is maintained and specific culture and histology requested. The disease is classified into invasive and noninvasive types, each being divided into two subgroups: invasive aspergillosis may be either fulminant or indolent and noninvasive disease localized or allergic. The literature is reviewed and an algorithmic approach to aspergillus sinusitis proposed. The importance of histologically differentiating invasive from noninvasive aspergillosis prior to selecting the appropriate treatment options is stressed. CT scan should precede definitive surgery, and be used in follow-up. Close and prolonged follow-up is essential.

We present a nine-month-old baby, diagnosed as having Pallister-Killian syndrome, whose referral and investigation for possible hearing loss has led to this diagnosis. Emphasis is placed on the importance of the skin biopsy for the diagnosis of this underlying genetic abnormality.

Extratympanic electrocochleography (ECochG) was performed on 37 patients referred to the Evoked Potential Clinic with suspected Ménière's disease. The patients were classified according to their hearing impairment and audiometric configuration. Click and tone-pip stimuli with tone frequencies of 1 and 4 kHz were presented at a rate of 10 per second. Amplitude, latency and general waveform characteristics of the summation potential (SP) and action potential (AP) were analysed for each averaged response with respect to the level and configuration of the hearing loss. The highest incidence of abnormal percentage SP was in patients with average hearing loss in the range of 40–64 dB HL using the click stimulus. In low tone hearing loss, hydrops was identified from an enhanced SP in significantly more patients using the click and 4 kHz tone-pip than the 1 kHz stimulus. Measurement of the width of the 1 kHz tone-pip response waveform was abnormal in some patients even though the click and 4 kHz responses were normal. The optimum stimulus for identification of hydrops from an enhanced SP is dependent on the level and configuration of the hearing loss.

Tonsillectomy is a commonly performed operation in children. Although the justification for this procedure has been debatable in the past, more rigorous criteria in defining the need for tonsillectomies are becoming established. The role of the primary care physician in the management of tonsillar disease in children is important as the decision to refer a child for tonsillectomy is made by the general practitioner. A questionnaire survey of 400 general practitioners (GPs) and 31 consultant ENT surgeons was carried out to establish the important criteria used in deciding the need for paediatric tonsillectomy. We found that in general there was a good correlation between GP and Consultant indications for tonsillectomy. However there were two important areas of difference, while most of the GPs felt that recurrent ear infections and ‘glue ear’ were important indications for tonsillectomy, Consultants did not. Therefore we must be aware of the current recommendations for tonsillectomy and inform present and future GPs.

Head and neck squamous cell carcinoma has a relatively good prognosis but treatment may be at the expense of function and quality of life. Various host and tumour parameters have been studied in an attempt to predict the course of the disease but without success. It has been hoped that laboratory based methods, particularly those based on molecular biology, may prove more useful. Cell kinetic parameters are studied in this paper.

The present study includes 75 patients with a proven squamous cell carcinoma of the head and neck at various sites and undergoing various forms of treatment. The patient's mean age was 62 years and the median survival rate 45 months. Immunohistochemical techniques using Ki67 and PCNA were compared with flow cytometric analysis which included the BRDU labelling index, the duration of S phase, ploidy and potential doubling time.

The median PCNA index was 560 and the Ki67 index 298. These indices varied between 980 and 150 for PCNA and 808 and 110 for Ki67. The BRDU labelling index measured by flow cytometry was 8.9 with a range from 25 to 1.6 and the duration of S phase was 14.8 hours. The PCNA index failed to correlate with any host or tumour factors and this failure was also seen in Ki67 indices and also in the flow cytometric parameters. There was a strong correlation between PCNA and Ki67 expression (p<0.0001). Neither PCNA nor Ki67 values were significantly different between irradiated and nonirradiated tissues nor in sites or in patients who later developed lymph node metastases. Neither PCNA nor any other cell kinetics parameter correlated with survival and multivariate analysis confirmed this lack of correlation.

The PCNA labelling index like the Ki67 index and flow cytometric parameters does not appear to be of value in predicting the course of squamous cell carcinoma of the head and neck.

The association of human papilloma viruses (HPV) with laryngopharyngeal squamous cell carcinoma is under investigation. The suitability of control tissue in the reported series, invariably obtained from histologically normal tissue adjacent to a squamous cell carcinoma or from patients with benign laryngopharyngeal disease, is questionable. The present study determined the prevalence of HPV in a series of normal larynges.

Twelve autopsy larynges were collected. DNA was obtained by SDS proteinase K digestion. Evidence of HPV infection was documented by the polymerase chain reaction using oligonulceotide primers complementary to sequences in the E6 region of HPV types 11, 16 and 18.

Four female and eight male larynges, mean age 65 years (sd=16 years) were collected 72 hours postmortem (median value). HPV type 11 was isolated from three specimens. A 25 per cent prevalence rate for HPV 11 was found. No other HPV types were isolated.

We present a solar recharging system for nickel-cadmium cells of interest in areas where batteries for hearing aids are difficult to obtain. The charger has sun cells at the top. Luminous energy is converted into electrical energy, during the day and also at night if there is moonlight. The cost of the charger and hearing aid is very low at 35 US$.

The use of solar recharging for hearing aids would be useful in alleviating the problems of deafness in parts of developing countries where there is no electricity.