This study examines the long-term results and morbidity of submandibular duct transposition in drooling children. Twenty-two patients, aged 3 to 18 years, with neurological dysfunction and excessive drooling underwent submandibular duct transposition between 1984 and 1987. In January 1990, 20 patients were reviewed. Their degree of drooling pre-operatively, immediately post-operatively and currently was assessed. The rate of improvement and the occurrence of complications were noted. Drooling was ‘much better’ in the early post-operative period in 17 of the 20 patients, and this improvement was invariably noted within three weeks. In the three other patients drooling was ‘better’. Deterioration occurred in only three patients over the entire follow-up period. Complications all occurred in the first 18 months following surgery; they consisted of salivary retention cysts in four and transient submandibular gland swelling in a fifth patient.

The ultrastructure of mast cells from the nine normal inferior turbinates were compared with those found in eight patients with perennial allergic rhinitis due to house dust mite allergy. Forty-six mast cells from normal patients were found in forty blocks and eighty cells were found in thirty-three blocks in patients with perennial allergy suggesting an increase of mast cell numbers in perennial allergy. There were no basophils outside the blood vessels and whole mast cells were found only in the submucosa. There was no difference in the morphology of cells of different sizes. Mast cells were more degranulated in the allergic mucosa. Degranulation, irrespective of cell size was found at all depths of the mucosa. A review of the literature covered the in vivo and in vitro descriptions of the ultrastructural morphology of human mast cells in the respiratory tract.

A study was understand in 43 patients to determine the role of surgery in tuberculous mastoidits. Cortical mastoidectomy was performed on five patients (Group I). Incision and drainage of a post-auricular abscess, removal of sequestrum and meatoplasty in eight (Group II).

Thirty patients had no ear surgery (Group III). Of the 17 Patients with facial palsy, three were in Group I, two in Group II, 12 in Group III. The patients in all three groups were treated with anti-tuberculous drugs for a period of no less than six months.

The average time taken for the otorrhoea to subside and granulation issue to resolve completely was two months in all three groups. The facial nerve recovery in the non-operated ears (Group I and II) 80 per cent.

The conclusion is that chemotherapy is the management of choice in tuberculous mastoidits. The only role of surgery is incision and drainage of a post-auricular abscess and removal of sequestrum if present.

Bleeding is the major source of morbidity and mortality of tonsillectomy and most operative time is spent securing haemostasis. Calcium alginate reduces experimental wound blood loss. This study assessed the efficacy of alginate swabs during tonsillectomy and inferior tonsillar pole ligation in the control of blood loss during tonsillectomy.

Ninety-nine tonsillectomy patients were randomized to gauze or alginate swab use. A haemoglobinometer measured blood losses collected by suction during dissection and by swab until haemostasis was secured. Operative time, complications and healing were also assessed.

Mean total blood losses and operative times were similar for the two groups. Swab blood loss was significantly lower for surgeons who ligated the lower tonsillar pole, compared with surgeons who used a snare. This finding was independent of swab type. Independent assessment showed no difference in the healing rate.

Alginate swabs offer no advantage over gauze in terms of blood loss, operative time or complications of tonsillectomy. The results show that routine lower pole ligation significantly reduces post-dissection blood loss. We suggest that this technique should be more widely adopted.

We present the results of a prospective study of 388 patients presenting with a history of swallowing a foreign body. We indicate whether the patients' symptoms and signs were associated with a retained foreign body. While tenderness on palpation was an unreliable sign, pooling at indirect laryngoscopy invariably predicted a retained object. In many patients, initial careful examination of the oropharynx by casualty officers would have shown a retained fishbone in the tonsil or tongue and would have resulted in 16 per cent fewer radiographs and 17 per cent fewer referrals to the ENT department. Radiography only improved management in a small minority and 35 per cent of films were interpreted incorrectly by casualty officers. A follow-up barium swallow disclosed a pathological lesion in a significant proportion of patients with bolus obstruction, whether or not this was passed spontaneously.

Magnetic resonance imaging is able to demonstrate a wide range of sinus abnormalities. Incidental findings in patients referred for neuroradiology because of suspected intracranial pathology are surprisingly common and were present in 37.5 per cent of 483 images examined. The maxillary and ethmoid sinuses were most commonly affected with 27 and 26 per cent of images abnormal whereas the frontal and sphenoid sinuses were less commonly affected with 5 per cent of each abnormal. If minor changes were excluded then 17 per cent of patients had either fluid, a polyp or marked mucosal thickening in at least one sinus. Nasal symptoms, other than the presence of a cold, showed no statistically significant relationship to abnormal findings. Many people with inflammatory changes in their sinuses demonstrated on MRI do not have symptoms classically attributed to sinusitis.

Two-hundred-and-twenty-one patients with squamous carcinoma of the oropharynx treated by irradiation are presented.

The primary recurrence rate at five years in the previously untreated patients was 27%, but was dictated by neither host factors (age, sex and general condition) nor tumour factors (site, T-stage and histological grade).

Pre-operative histological diagnosis had a very high sensitivity but a low specificity, indicating that false positives are common but false negatives unusual. Twenty per cent of patients with a recurrent primary tumour were untreatable.

The five year survival after a primary recurrence was 31 per cent. Sixty-eight per cent of patients undergoing major surgery recovered without a major complication, and the hospital mortality rate was three per cent, due entirely to major medical catastrophes. The major complication rate in those undergoing flap repair after major resection was seven percent.

The metastatic rate in lymph nodes was 44 per cent at five years, and again this did not depend on any host or tumour factors. The survival at five years after node recurrence was a mere 19 per cent, and the length of survival was related to the primary site of the original tumour and the presence of extranodal disease. Two-thirds of patients had advanced disease (N2 and N3) when node recurrence was diagnosed and about 15 percent were unsuitable for surgery.

Cytomegalovirus (CMV) is a common opportunistic infection in both iatrogenic and HIV-induced immunosuppression. The usual sites of involvement are the gastro-intestinal tract, retina and lung. We present three cases of CMV ulceration of the oropharynx. All three patients presented with symptoms localized to the oropharynx and in each case the diagnosis was only made on histological examination of ulcer biopsy specimens. The patients all responded well to ganciclovir treatment and at writing none have required maintenance therapy (7–11 months post diagnosis).

Acute epiglottitis in the adult is a rare disease, which has shown an appreciable increase since the sixties and in our locality since 1984. We present a review of the cases registered in our hospital, analyzing their aetiology, evolution and treatment. The disease is most likely to be suspected in the presence of any patient having a sudden dysphagia. especially if he shows symptoms of an acute infection and a lack of oropharyngeal pathology.

Thirty-three cases of nasopharyngeal carcinoma are reported. This is the first report of this condition from Jordan. Age, sex, early presentation and metastases are discussed. Bimodal distribution of age showed two peaks between 16–20 and 41–45 years. The disease was more common in males. Lymph node enlargement was the most common presentation, and bone metastases were the most frequent.

Ear drops are prescribed widely with little thought for the distribution inside the ear canal. This study compares the distribution of water and oil based drops. The results indicate that, under the test conditions, the penetration of ear drops is extremely variable. Water provided the greatest overall coverage, while the most viscous drops fared worst. It is suggested that in diseased ears even poorer penetration may result, which may explain the lack of response in some circumstances.

A retrospective study comparing adverse events usin bismuth iodform paraffin paste (BIPP) and Xeroform as dressings for newly fashioned mastoid cavities after mastoidectomy was undertaken. There were 20 patients in each group. Adverse events were defined as offensive packs, mastoid caivity infection and systemic signs of infection. There were no adverse using BIPP packs Whether or not prophylactic antibiotics were used. Xeroform packs were associated with a significantly higher incidence of adverse events compared to BIPP when using on antibiotic porphylaxis (P<0.005) or amoxycillin (P<0.005). Adverse events with Xeroform packs were abolished using ciprofloxacin and metronidazole prophylaxis. We conclude that BIPP is the mastoid dressing of choice.

Nasal symptoms are a frequent cause of referral to paediatric ENT clinics. It is the policy of our unit to view sinus radiographs without a report at the initial clinic attendance. This study demonstrates there is no statistically significant difference in the interpretation of the radiographs between two ENT surgeons and a radiologist although there was a tendency for the radiologist to have a greater specificity. This finding may have financial implications. In addition a clear sinus radiograph is shown to be a significant negative finding.

Severe, diffuse polyposis can be adequately treated through a transnasal approach which combines microscopic and endoscopic surgery. The operating microscope is used to perform ethmoidectomy, usually from the front to the back, and to open the sphenoid sinus and the antral window. The telescopes allow the sphenoid and maxillary sinuses to be cleaned under direct view control as well as enabling good drainage to be performed from the frontal sinuses. The results from 22 consecutive patients were good, with a very low rate of minor post-operative complications.

Primary atrophic rhinitis seems to have a high prevalence in the arid regions bordering the great deserts of Saudi-Arabia. Fibre-optic endoscopy was performed on 42 patients treated surgically. Fibre-optic endoscopy demonstrated the presence of crusts in the nasal cavities and their subsequent reduction following surgery. It also demonstrated ulceration of the cartilaginous nasal septum in some cases and this may explain the pathogenesis of septal perforation noted in a high number of our patients. Fibre-optic nasendoscopy was also helpful in demonstrating the reappearance of free mucus in the nasal cavity and helped to determine the optimal time for reversing Young's procedure. Fibre-optic nasendoscopy is a reliable tool for verifying the results of surgery and comparing the efficacy of various treatment modalities.

Failure to get relief from topical steroid nasal spray is often blamed on poor administration knowledge. In a population of patients referred to the rhinitis clinic who have failed to get relief from topical steroid nasal spray when prescribed by the general practitioner, lack of patient education only accounts for 28 per cent of patient treatment failures and other factors e.g. poor compliance, erroneous diagnosis or severity of rhinitis will be responsible for the rest. Information leaflets are considered to be a good idea by nearly all patients but this study demonstrates that they would only be of therapeutic benefit to a minority of patients.

A large variety of graft materials have been used for augmentation rhinoplasty. To date there has been no graft material which can be regarded as completely satisfactory. The modern trend is to prefer autologous material to new biological material. The membranous bones of the calvarium are extremely suitable for augmenting moderate to severe saddle nose deformities. Calvarial bone grafts can be harvested easily, with minimum donor site morbidity and disfigurement. Our experience with calvarial bone grafts for augmentation rhinoplasty is presented.

The enlarged adenoid is a common disorder in children resulting in nasopharyngeal obstruction. Many authors suggest that increased nasal resistance to respiration may cause disturbances in the pulmonary ventilation and carry the risk of obstructive sleep apnoea and/or cardiopulmonary syndrome.

This study comprised 30 children complaining of long-standing nasal obstruction due to enlarged adenoids. Adenoidectomy was performed and the arterial blood gases were measured before and one month after surgery. Twelve normal children were also included as controls. Statistical evaluation of the results showed that O2 saturation and arterial O2 tension (PaO2) were significantly low before the operation, and increased significantly after surgery. Arterial CO2 tension (PaCO2) was insignificantly low before operation, but decreased significantly after adenoidectomy. It was concluded that enlarged adenoid may be associated with ventilatory impairment which is reversible after adenoidectomy.

Two cases of habitual pinna folding are reported. One case was complicated by the development of bilateral haematoma auris as a direct result of the trauma caused by the folding.