This paper presents our experience with four cases of impacted laryngeal foreign bodies. A review of the literature reveals that the condition is rare, but far more dramatic and life threatening than bronchial foreign bodies. The history may not indicate the diagnosis, especially in the ethnic minority races where there is a language barrier. Suspicion of the diagnosis by the causalty officer and the immediate attendance of an experienced otolaryngologist may be life saving.

Radiological examination is not necessary where the diagnosis is obvious. If the diagnosis is in doubt it must be remembered that many foreign bodies are not radio-opaque. The patient must be accompanied at all times by an otolaryngologist until the foreign body is removed.

An unusual use of joss sticks leading to anterior nasal stenosis is presented.

The value of tubal inflation as a diagnostic procedure for Eustachian tube patency and function is controversial. In an attempt to assess the diagnostic value of air douche in atelectatic ears, 49 such ears of 40 patients were politzerized. The procedure was successful in 45 ears. However, of the four unsuccessful cases, two of the patients were able to autoinflate their ears. These results show that air douches pass regularly through the Eustachian tube into the tympanic cavity even in atelectatic ears, which by definition suffer from aeration deficiency, which is often considered to be secondary to ‘Eustachian tube obstruction’, or alternatively ‘Eustachian tube dysfunction’. Thus, the ability to force air through the Eustachian tube by politzerization is of no diagnostic value as an indicator of normal or abnormal tubal patency or functioning in atelectatic ears and most probably in allied conditions.

We report the association of an auronasopharyngeal poiyp arising in a congenitally abnormal middle ear and Eustachian tube. Subsequently, ten years after removal of the polyp and insertion of a ventilation tube, there was recurrence of the polyp in association with cholesteatoma of the middle ear.

Eight cases of intra-thoracic tracheal stenosis presenting to the ENT department at the Hospital for Sick Children, Great Ormond Street, over the past 10 years are reported. The varied aetiology and presentation of these cases is discussed and the frequency of associated cardio-pulmonary anomalies emphasized. Difficulties in diagnosis and investigation are outlined, in addition to an overview of current management. While the overall outlook for many of these children remains poor there is reason to believe that a balance of conservative management and surgical reconstruction in selected cases will result in improved survival figures.

Intranasal adhesions are a common complication following nasal surgery. They may be prevented by the use of silastic splints, which are also a very effective treatment for established lesions. We report a patient where intranasal adhesions rapidly recurred despite the use of splints, who was found to be suffering from Wegener's granulomatosis.

A case of recurrent Bell's palsy occurring in two successive pregnancies in a 37-year-old woman is presented. The causes of facial nerve paralysis of the lower motor neurone type are discussed. The rate of recurrence of Bell's palsy during pregnancy is unknown. Treatment with corticosteroids of Bell's palsy during pregnancy poses the threat of possible side effects on the fetus.

The case of an 18-year-old man who presented with a large cystic mass in the floor of the mouth extending into the left submandibular triangle of the neck is reported. Histopathology of this mass, which was totally excised by a combined intra-oral and cervical approach, confirmed it to have originated in ectodermal remnants (congenital dermoid cyst) and to be actively secreting sebum. This case is reported both because dermoids at this site are rare because they may present some problems in management.

The case of an osteosarcoma arising in the mandible of a six-year-old child is presented. It was originally misdiagnosed as a desmoplastic fibroma, and after initial curettage continued to grow for twelve years. The differential diagnosis is presented and details of the surgical access and difficulties encountered in the surgical removal of this very large tumour are described.

The relationship between pre-existing disease and osteosarcoma of the mandible is discussed, and the difficulties experienced in distinguishing between the fibro-osseous lesions and osteosarcoma of the mandible are highlighted.

The case is presented as a well-differentiated, intra-osseous osteosarcoma with subsequent transformation into a high-grade, conventional osteosarcoma.

Recent reports have dispelled the previously held concept that head and neck cancer rarely metastases beyond the cervical lymph nodes. Nasopharyngeal cancer has been reported to have a higher incidence of distant metastases compared to other head and neck cancers, the common sites being bone, lung and liver. A case of nasopharyngeal carcinoma presenting as obstructive jaundice because of secondaries at the porta hepatis is presented here.

To evaluate whether age over 70 years represents a prognostic factor in head and neck cancer, we reviewed all cases observed between 1981 and 1984. Four hundred and thirty-eight (438) patients were considered in relation to three age groups (<59, 60–69, and >70 years, defined as non-elderly, mid-elderly and elderly respectively).

The main parameters analyzed included histological diagnosis (no difference emerged among the three age groups); anatomical site (hypopharyngeal carcinoma was most frequent in non-elderly patients); TNM stage (an higher incidence of early stages was seen in the elderly); performance status (better in the nonelderly); previous illnesses (life-style related diseases were more frequent in the non-elderly); contraindications to surgery (more frequent in the elderly); surgical treatment (‘en bloc’ resections were more often employed in the non-elderly); post-operative complications and local control (no difference between the three groups); multiple primary malignancies (head and neck, oesophagus and lung were more frequent in non-elderly patients) and survival (no difference).

Although age affects several features of head and neck cancer patients, it does not appear from the present study to be an independent prognostic factor for local control and survival. With regard to survival, stage appeared to be the most important prognostic factor.

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a rare but life-threatening complication of trans-sphenoidal pituitary adenomectomy. It has previously only been described as a late phenomenon. We report an early presentation within the first week. The pathophysiology, clinical features and treatment are discussed.

A case is described of osteochondroma of the tongue and the literature on osteomata, chondromata and osteochondromata of the tongue is reviewed. The tendency for these tumours to arise in the region of the foramen caecum has been noted in previous reports as has the female preponderance. It has been suggested that they arise from remnants of branchial arch cartilage. The variation in the duration and age at presentation of the lesion has not been explained and an alternative theory is suggested.

A case of T1N0M0 carcinoma of the tongue in a male 23-year-old ‘regular’ marijuana smoker is described. Hemiglossectomy and complete bilateral neck dissection were carried out. No post-operative radiotherapy was given as the resection margins were histologically negative. The tumour recurred one year later in the left cervical region involving the mandible and surgery was again performed, but after three months, neck disease was still evident. The case described case implies the introduction of marijuana as a possible new risk factor in the development of oral cavity tumours. Resection of the primary lesion has to be as wide as possible even in T1 cases, due to the aggressive biological behaviour of such tumours in young subjects.

Foramen magnum tumours are rare. They may present with bizarre symptoms and mimic many conditions. We report a presentation with the sole complaint of hoarseness, never previously described in the literature. Voice returned to normal after surgical removal of the foramen magnum meningioma.

Kawasaki disease (mucocutaneous lymph node syndrome) is an acute vasculitis of childhood carrying a 1–2 per cent mortality from cardiovasular complications. Despite the extensive literature on Kawasaki disease in paediatric journals, there has been a paucity of documentation in the otolaryngological literature. This is despite the fact that Kawasaki disease may present as an otolaryngological emergency before the diagnosis is established. We describe three cases of Kawasaki disease, all of which presented to the ENT department of this hospital within a period of two months. These cases illustrate the slow evolution characteristic of the disease and highlight the difficulties of diagnosis in the initial febrile stage. We emphasize the importance of considering the diagnosis when treating a young child with a pyrexia resistant to antibiotics, as prompt introduction of therapy may decrease the risk of fatal coronary artery or cardiac involvement.