To describe the differential diagnosis of recurrent or bilateral peripheral facial palsy.

Case report and literature review.

Two patients with recurrent, alternating, peripheral facial palsy are described. In both patients, additional investigation was performed to search for a specific diagnosis. In the first patient, only a positive family history was found, indicating a possible familial susceptibility. In the other patient, diabetes mellitus and hypertension were identified as risk factors.

There is an important and extensive differential diagnosis of recurrent or bilateral facial palsy. However, in a large proportion of patients the cause remains unknown.

A musical hallucination is defined as a form of auditory hallucination characterised by the perception of music in the absence of external acoustic stimuli. It is infrequently cited in the literature, although population studies suggest a greater prevalence. The aetiology of this unusual disorder remains unclear.

A 70-year-old man with acquired hearing loss suffered a whiplash injury in a low-speed road traffic accident, and subsequently presented with bilateral ‘tinnitus.’ On closer questioning, he described hearing orchestral music. There was no evidence of psychosis, delirium or intoxication, and the patient was managed expectantly.

This patient represents the first published case of musical hallucination precipitated by whiplash injury. We explore the possible pathophysiological underpinnings of musical hallucination and highlight the need for a greater awareness of this disorder. A management strategy is suggested.

We report two extremely rare cases of polyps from unilateral accessory middle turbinates, one of which coexisted with a polyp from an inferomedially projecting, pneumatised, secondary middle turbinate.

Case report and literature review concerning accessory middle turbinate and secondary middle turbinate.

Two patients presented with unilateral nasal obstruction. In both patients, nasal endoscopy revealed polypoid masses originating from the middle meatus. Paranasal sinus computed tomography and histopathological analysis confirmed the presence of polyps originating from an accessory middle turbinate and secondary middle turbinate, which were resected uneventfully via endoscopic sinus surgery.

To our knowledge, this is the first report in the world literature of polyps originating from a unilateral accessory middle turbinate and secondary middle turbinate. Pre-operative recognition of these rare anatomical variations is of particular importance in avoiding intra-operative complication.

To report a series of pitfalls and complications in a case of cochlear implantation.

Case report.

An 11-year-old boy affected by auditory neuropathy underwent cochlear implantation. Intra-operative assessment was apparently consistent with correct insertion of the electrode array into the cochlea. However, subsequent high resolution computed tomography revealed that the entire electrode array was curled up within the vestibule. Revision surgery was complicated by cerebrospinal fluid leakage. A straight probe was repeatedly inserted into the internal auditory canal, before conversion to a canal wall down procedure and appropriate positioning of the electrode array.

In this case, mild anteriorisation of the facial nerve created an awkward insertion angle for the electrode array via the retro-facial route, which may have triggered the described series of adverse events.

We describe a case of bilateral congenital choanal atresia in the oldest patient reported with this condition in the recent English language literature.

Case report and a review of the relevant English language literature, presenting the embryopathogenesis, diagnostic methods and treatment options for this condition.

A 53-year-old woman having difficulty with nasal breathing, and with a continuous nasal discharge, was admitted to our clinic. Bilateral congenital choanal atresia was diagnosed by endoscopic examination and paranasal sinus computed tomography. Surgical treatment used an endoscopic transnasal approach. The follow-up examination a year later revealed adequate choanal openings bilaterally.

To our knowledge, this is the oldest patient with bilateral congenital choanal atresia to be reported in the recent literature. This condition is rarely encountered in adulthood but should be considered as a possible differential diagnosis of persistent nasal obstruction.

Temporomandibular joint fistula into the external auditory canal is a very rare condition. We report a case of spontaneous fistula which presented with repeated episodes of clear fluid otorrhoea and ear infection.

A 53-year-old woman complained of occasional episodes of clear fluid otorrhoea from the right ear followed by infection. Otoscopic examination showed a normal tympanic membrane and normal skin in the external auditory meatus. Otomicroscopy showed a small punctum on the anteroinferior part of the meatus. Computed tomography identified a foramen of Huschke. Surgery revealed a fistula between the meatus and the temporomandibular joint, which was successfully resolved.

This report presents a rare case of a fistula between the temporomandibular joint and the external auditory meatus, associated with Huschke's foramen. Such a defect can be quite difficult to detect. It should be suspected in cases of chronic otorrhoea when neither middle nor external ear disease is apparent. Surgery is usually successful, and is advised in cases with repeated complications.

Subclinical infection of the sinuses can result in delayed diagnosis and unusual presenting complications.

This paper describes the case of a 14-year-old boy with a rare combination of periorbital cellulitis, subgaleal abscess and superior sagittal sinus thrombosis following a late presentation of unilateral frontal sinusitis.

Following multiple surgical procedures, and antimicrobial and anticoagulation therapy, the patient made a full recovery.

Serious sinusitis complications still occur, and can do so in unusual combinations with minimal clinical signs. Systemic anticoagulation therapy is considered safe practice in the management of cerebral venous sinus thrombosis and may reduce morbidity and mortality.

To report the first case of treatment of Nager syndrome associated conductive hearing loss with bone-anchored hearing aids, in a three-year-old boy.

Clinical case report and current literature review regarding the use of bone-anchored hearing aids in the treatment of conductive hearing loss in children.

A three year eight month old boy with Nager syndrome was successfully treated for conductive hearing loss using bilateral bone-anchored hearing aids.

This is the first case report of the use of bone-anchored hearing aids to treat Nager syndrome associated conductive hearing loss. Treatment was safe and successful in this case.

Hereditary haemorrhagic telangiectasia is an autosomal dominant condition characterised by multiple venous malformations of the skin and mucous membranes which can bleed on contact. A Young's procedure is used to control severe epistaxis in patients with this condition. However, there has been no previous report of a reversal of Young's procedure in such a patient.

A patient with hereditary haemorrhagic telangiectasia had his Young's procedure reversed under general anaesthetic by dividing the mucocutaneous flaps. Nasal vestibule patency was maintained using a custom-made silicone nasal mould. Intra-operative photographs show the patient's nasal mucosa shortly following reversal of his Young's procedure, and also illustrate the creation of the custom-made nasal mould.

Stopping airflow through the nasal cavity via a Young's procedure prevents the telangiectasia from bleeding but does not make them disappear completely. Young's procedure does not seem to have any long-lasting effect on the nasal mucosa of patients with hereditary haemorrhagic telangiectasia.

To evaluate the presence of Helicobacter pylori in healthy laryngeal mucosa.

Prospective analysis of Helicobacter pylori colonisation in healthy laryngeal mucosa, using the 13C urea breath test and polymerase chain reaction analysis.

Twenty randomly chosen men (28–78 years) without laryngeal pathology or gastrointestinal disease were investigated. All subjects were scheduled for elective operative procedures, under general, endotracheal anaesthesia. Cytobrush samples were taken for Helicobacter pylori DNA detection. Nested polymerase chain reaction testing was performed on DNA solutions using two primer pairs from the urease A gene of the Helicobacter pylori genome. The 13C urea breath test was performed on two exhalation samples.

Eight (40 per cent) of the subjects were positive for urease on urea breath testing; none were positive for Helicobacter pylori DNA on polymerase chain reaction testing.

Based on these results, we do not consider Helicobacter pylori to be a normal constituent of healthy laryngeal microflora.

To discuss the pathophysiology of atlanto-axial subluxation as a rare complication of tonsillectomy, and to discuss the important radiological findings for diagnosis and treatment planning.

We report a case of post-tonsillectomy atlanto-axial subluxation, also known as Grisel's syndrome, in a child. On the third day after surgery, the boy presented with torticollis with no neurological deficit. Rotatory atlanto-axial subluxation was clearly shown in computed tomography scans of the neck. Cervical traction for one week successfully reduced the subluxation, with no long-term sequelae.

Pre-existing cervical ligamentous laxity and post-operative infection are believed to be the main causes of Grisel's syndrome. Although it is rare, patients are advised to seek treatment early if any neck pain or fever persists. Early diagnosis is important for better treatment outcome. Initial conservative measures are advised before more invasive cervical traction is adopted.

We present the first report of a case of neuroendocrine carcinoma of the paranasal sinuses treated successfully with radiotherapy alone.

A case report and literature review are presented.

Fewer than 50 cases of paranasal sinus neuroendocrine carcinoma have been reported. We present an 82-year-old man referred with recurrent epistaxis. He was investigated by biopsy, computed tomography and magnetic resonance imaging, and was found to have a rare neuroendocrine carcinoma. He declined any surgery or chemotherapy but consented to radiotherapy. Thirty months later, he remained clinically free from cancer.

There is no consensus for the management of paranasal sinus neuroendocrine carcinoma. Most cases are treated with surgery with or without chemoradiotherapy. This case shows that radiotherapy alone may be a viable treatment option for some cases.

Meningiomas are slow-growing, benign tumours originating from the arachnoid villi of the meninges. They account for 13 to 26 per cent of all intracranial neoplasms. Less than 1 per cent of all meningiomas are primary extracranial tumours of the ear and temporal bone. Intracranial meningiomas extending to the middle-ear cleft are uncommon, with fewer than 100 cases reported to date. Presenting symptoms of the latter condition may include hearing loss, tinnitus, dizziness, vertigo and facial palsy. Otitis media with effusion secondary to eustachian tube dysfunction has also been reported.

To describe three patients in whom chronic otitis media was the presenting sign of skull base meningioma.

Case presentations.

Presentation of clinical and imaging findings as well as management considerations.

Meningioma involving the middle ear is an extremely rare condition, and is diagnosed by computed tomography in conjunction with magnetic resonance imaging. When biopsy is performed, the histological features, characteristic immunophenotype and ultrastructural analysis are valuable aids to definitive diagnosis. In patients with no neurological symptoms, ‘wait and scan’ is often the best management option.

Glomangiopericytoma is a rare sinonasal tumour of perivascular myoid phenotype, which accounts for less than 1 per cent of all sinonasal tumours.

Discussion of the clinical presentation, histopathological features and advances in the management of sinonasal and skull base glomangiopericytoma.

A 32-year-old woman presented with worsening nasal obstruction, anosmia, severe frontal headaches and right-sided proptosis. Radiographic and endoscopic examination revealed a right-sided, vascular mass involving the nasal cavity, paranasal sinuses and anterior skull base. Histopathological features were consistent with a glomangiopericytoma. Complete endoscopic resection with free margins was achieved.

Glomangiopericytomas are rare, vascular, sinonasal tumours. Successful management depends on complete resection, traditionally achieved via an open approach. However, recent advances in endoscopic surgical approaches have enabled complete endoscopic resection of these tumours, minimising morbidity and facilitating subsequent surveillance of the operative site.

We report the case of a successful cochlear implantation in a patient with severe cochlear hypoplasia.

The outcome of cochlear implantation is generally less favourable for patients with cochlear hypoplasia than for those with a normal cochlear structure. In the reported patient, part of the electrode array was inserted into the internal auditory canal. Nevertheless, the benefits following cochlear implantation seemed to outweigh the risks for this patient.

Cochlear hypoplasia is not necessarily a contraindication for cochlear implantation.

We report the use and benefits of the ultrasonic dissector in the resection of difficult skull base lesions.

Five case reports are presented, and the utilisation of ultrasonic dissectors in otorhinolaryngology is reviewed.

The ultrasonic dissector was found to be a useful tool during the endoscopic resection of poorly accessible skull base tumours. Safe dissection and complete removal of all five lesions were achieved without any vascular injury. To our knowledge, this is the first report of the use of the ultrasonic dissector for the resection of sinonasal and skull base tumours.

The ultrasonic dissector was found to be particularly useful during the endoscopic transnasal approach to the petrous apex. During minimally invasive endonasal surgery, benefits include the length of the instrument, speed and precision of dissection, and low risk of vascular injury.

Presentation of a case of perioral Frey syndrome.

Case report.

A 72-year-old woman with hyperhidrosis around the mouth and chin.

This patient suffered from bilateral perioral gustatory sweating following a mandibular osteotomy; such a case has not previously been described. Possible pathophysiological hypotheses are discussed in relation to the anatomy and innervation of the salivary glands.

Perioral gustatory sweating is a rare complication of osteotomy.

We report a rare case of small cell neuroendocrine carcinoma of the nasal cavity and paranasal sinuses with intracranial extension, and discuss the management of this rare tumour.

Small cell neuroendocrine carcinoma involving the nasal cavity and paranasal sinuses with intracranial extension may be treated successfully with surgery alone, without development of local recurrence.

Small cell neuroendocrine carcinoma is a locally aggressive tumour with a high rate of recurrence. Early and aggressive surgical excision with or without radiotherapy or chemotherapy can improve a patient's outcome and prognosis. Regular follow up is needed to detect any local or distant recurrence.