Tissue engineering is the development of biological substitutes for the repair and regeneration of damaged tissues. We explain the principles of this emerging field of biotechology. The present and potential applications of tissue engineering technologies in ENT surgery are then reviewed.

Gordon Smyth had a deep emotional investment in closed cavity surgery for cholesteatoma but, nonetheless, later acknowledged that he believed that he had been mistaken. Emotional investments create problems for all surgeons. Sometimes they have difficulty in recognizing that they need to change what they are doing. This is especially important in the management of Ménière’s disease where unproven surgical procedures are often perpetuated. Surgery on the endolymphatic sac is of doubtful value but still continues to be the most frequently performed operation for this condition. Surgeons need to reconsider the evidence and question the appropriateness of these operations.

Parapharyngeal space tumours account for only 0.5 per cent of all head and neck tumours. Due to their inherent location, they present with varied non-specific signs and symptoms, resulting in a delay in diagnosis and unnecessary procedures, such as a ‘tonsillectomy’ or ‘incision and drainage’ of a ‘quinsy’. Thirty-one patients, operated on over an 18-year period (1981 to 1998), in the Department of Otolaryngology, Singapore General Hospital, are presented. Their ages ranged from 21 to 86 years, with a mean of 52 years, with equal sex distribution. The commonest aetiology was a deep lobe of parotid tumour (44 per cent), followed by neurilemmomas (18 per cent), there was only one paraganglioma. The transcervical and transparotid approaches were the commonest used. The mean surgical time was three hours, mean hospital stay was 5.3 days and post-operative complications were minimal. The average follow-up time was 5.6 years. Although parapharyngeal space tumours are uncommon, recognizing them would enable the correct sequence of investigations, instead of unnecessary procedures resulting in an increased morbidity for the patient.

This article reviews the contemporary literature for septic cavernous sinus thrombosis (CST) with a focus on anticoagulation. Modern emphasis is placed on suspecting and treating this condition early, which is aided by recognizing clinical features attributable to sepsis, orbital venous congestion, and involvement of cranial nerves within each cavernous sinus. Established treatments include high dose broad-spectrum parenteral antibiotics, and selective surgery for concurrent suppurations. The role of anticoagulation is contentious because its efficacy is undetermined and it may cause or exacerbate concurrent intracranial haemorrhage in patients with septic CST. Moreover, prospective trials of anticoagulation may never be performed due to the rarity of this condition. Nevertheless, retrospective reviews of published reports indicate that haemorrhage caused by anticoagulation is rare, and that early adjunctive anticoagulation is beneficial in these patients if commenced after excluding the haemorrhagic sequelae of CST radiologically.

The aim of this work was to determine the effect of extracorporeal shock wave lithotripsy (ESWL) on the hearing of both patients and staff members exposed to such treatment. It used different hearing screening instruments, and compared the sensitivity of these instruments for the detection of the earliest change in hearing induced by this procedure.

The results of this study show that ESWL has a potentially hazardous effect on hearing. This effect is subtle, could only be detected by transient evoked otoacoustic emissions (TEOAE), and is manifested in some of the subjects under study as temporary subjective hearing loss and tinnitus, reflecting a state of temporary biomechanical derangement of the outer hair cells. This effect seems to be related to the frequency of exposure to ESWL.

This study was performed to determine the historical development of the techniques used to represent the pathologic conditions of the tympanic membrane. The first coloured attempts were the drawings of Adam Politzer in 1865. Over the following 50 years other otologists produced their own atlases of drawings. At the beginning of the 20th century some otologists tried to photograph the tympanic membrane but without success. This method was progressively improved and by 1960 two techniques were used: through a speculum or with a microscope. The quality was not optimal, and for this reason, atlases produced during this period were with retouched or water-coloured photographs. It was with the discovery of new endoscopic fibres at the beginning of the 1960s that endoscopic photography progressively replaced all other methods. The precision of these pictures is very important for improving the quality of teaching of the different tympanic membrane pathology.