Minoan civilization was one of the civilizations of the past and flourished in the island of Crete between the years 2600 B.C. and 1100 B.C. Archaeological excavations brought to the light buildings and items, showing that the Minoans had an extensive knowledge about hygiene and health matters.

Among the items were idols, depicting anatomical parts of the human body and different pathological changes. These idols were offered by suffering people to gods and goddesses in order to beg for their help in curing them.

In a study carried out on idols kept in the Heraklion Museum, a number of interesting anatomical details and pathological changes, concerning the head and neck area were recognized.

Following stimulation of one ear with white noise (WN) or 0.5, 1 and 2 kHz tone bursts a statistically valid mean reduction in the amplitude of delayed evoked otoacoustic emissions (DEOE), elicited from the contralateral ear by bursts of the same frequencies, was observed in 10 people (19–23-years-old) with normal hearing. This reduction only appeared in response to a contralateral stimulus delivered 7, 8 and 9 ms earlier than that used to produce the DEOE. This inhibitory effect was just referable to the activity of the medial olivocochlear efferent system (MOES). This research has shown that: (i) the cochlear interdependence is linked to activation of the MOES; (ii) in man the activity of MOES is inhibitory and only appears for a stimulus of the same frequency or (for WN) including that used to elicit DEOE; (iii) the cochlear interdependence is frequency selective and the MOES thus establishes a direct functional interdependence between homologous sectors of the organs of Corti on the two sides; (iv) DEOE would appear to be no more than partly generated by outer hair cells (OHC) of the organ of Corti in relation to the frequency of the stimulus employed, thus substantiating the hypothesis that in their production the effects of an 'active' mechanism, represented by the 'slow' contractile activity of the OHC, is overlain by those of a 'passive' mechanism formed by the oscillations induced by the movements of the stapes in the basilar membrane (BM) or in the set of membranes and liquids of cochlear canal.

This retrospective study compares the tympanoplasty success rate when using a xenograft (Zenoderm) or an autograft (temporalis fascia).

Fifty-three ears were operated on over a three-year period. All the tympanoplasty operations were performed by the same surgeon. There were 43 ears in the temporalis fascia autograft group and 10 ears in the Zenoderm xenograft group. Both groups were similar with respect to patient age, type of tympanoplasty, area of tympanic membrane perforation and condition of the contralateral ear.

The tympanoplasty success rate in the temporalis fascia autograft group was 95 per cent. The tympanoplasty success rate in the Zenoderm xenograft group was only 40 per cent. All Zenoderm tympanoplasty failures were regrafted with temporalis fascia autograft. There was a 100 per cent success rate with this salvage surgery.

In conclusion, we suggest that Zenoderm is not a suitable graft material for tympanoplasty.

Mucociliary and equipressive eustachian tube functions have been studied, using saccharin solution (five per cent sodium saccharinate) and tubal manometry respectively, in 58 ears with chronic disease undergoing tympanoplasty. The position of the perforation site determines the results as the poorest results are obtained from the posterior ones, positive cases (47 per cent) and mean transport time (37.7 minutes), compared to the greater percentage of positive cases (86 per cent) and mean transport time (22.2 minutes) for anterior perforations.

When both parameters are analysed together there is a direct relationship between normal equipressive function and normal mucociliary transport time and between negative transport time and tubal blocking. Significant differences in transport times have been found for the anterior and posterior perforations being shorter for the anterior ones.

When surgical outcome is correlated with mucociliary transport, the normal transport time percentage is seen to be considerably higher in the success group (50 per cent) than in the failure group (22 per cent).

External otitis is an extremely common condition and can affect between five to twenty per cent of the patients attending ENT clinics (Hawke et al., 1984).

Its precise pathogenesis remains unclear, despite several aetiological classifications in the literature. The aim of this study was to investigate the relationship between infection, water exposure and trauma and the development of acute otitis externa. The study comprised 100 patients with their first attack of otitis externa and 150 age and sex matched controls. In only 40 per cent of cases could a primary microbiological cause be found.

There was no significant statistical difference found between the two groups regarding the use of agents capable of traumatizing the external canal. Regular swimming, showering and hair washing were significantly more common in patients with acute otitis externa. Allergic disorders were nearly three times more common in the external otitis group suggesting a possible immunological aetiology.

Ninety-five patients undergoing routine nasal surgery were enrolled into a randomized, prospective trial to investigate the efficacy and morbidity of nasal packing. The patients were randomized to receive a bismuth iodoform paraffin paste (BIPP) pack, a Telfa pack or no pack. Patients for septal surgery were randomized between the BIPP and Telfa groups only. They were independently randomized to receive or not receive, a silastic nasal splint for the first post-operative week.

Post-operative pain levels were analysed using a visual analogue scale. Mean pain scores were increased 50 per cent by the use of nasal packs and pack removal, particularly BIPP which, was a most painful event (p<0.001).

Reactionary haemorrhage occurred in only two patients (2.1 per cent), both of whom had packs in situ. Vestibulitis was unique to the patients with a silastic splint, who were packed with BIPP, occurring in 21 per cent of them. Similarly septal perforation was unique to this group. There was no significant difference in the incidence of adhesions between the groups which received packs and those who did not.

Routine nasal packing, especially with BIPP, would seem difficult to justify in view of the increased pain levels and increased complications which occur without any demonstrable benefit in the majority of patients. Therefore packing should be reserved for cases where there is concern about persistent haemorrhage. In these cases Telfa would be preferable to BIPP.

A random prospective study of 180 patients with chronic nasal obstruction who underwent inferior turbinate resection as a part of a multinasal surgical procedure is presented. The aim of our study was to examine the influence of nasal pack on the incidence of post-operative haemorrhage following inferior turbinate resection.

The haemorrhage rate in Group 1 (no nasal pack), Group 2 (nasal pack retained for 24 hours) and Group 3 (nasal pack retained for 48 hours) was 11.7, 8.3 and 0 per cent respectively.

We recommend that a nasal pack should be retained for 48 hours following inferior turbinate resection.

This study compares the relative thermal damage caused by a surgical CO2 laser and the Erbium: YAG laser when used to incise the human vocal fold in vitro. Results show that charring is completely eliminated when using the Erbium: YAG laser. The depth of coagulative necrosis adjacent to an incision is reduced from 510 ±m(µ 75) using the CO2 laser to 23 ±m(µ 12) using the Ebrium: YAG laser and at the base is reduced from 125 ±m (µ 45) using the CO2 laser to 12 ±m (µ 8 ) using the Erbium: YAG laser. The potential advantages regarding post-operative healing after laryngeal surgery are discussed.

Seventy-four patients with Stage T3 NO MO squamous carcinoma of the glottis were treated initially by either surgery or radiotherapy between 1980 and 1985. The treatment adopted was determined by consultant preference. The long-term survival in both groups was approximately the same. Of 38 patients treated initially by radiotherapy, 25 had local recurrence. Fifteen of these underwent salvage surgery and 10 died of disease. Thirteen patients (33 per cent) retained their larynx. One of the major advantages of treating patients with stage T3 NO MO carcinoma of larynx by radiotherapy initially is that approximately one-third will retain their larynx. Local recurrences can usually be treated readily by salvage surgery.

Through a combination of retrograde staining by wheat germ agglutinin (WGA) and immunohistochemistry, calcitonin gene-related peptide (CGRP)-reactive sensory neurons projecting from the laryngeal mucosa were detected in the feline nodose ganglion. The size of the CGRP-immunoreactive cell which was regarded as a laryngeal sensory neuron, was about 60 ±m in diameter: the shape of the immunoreactive laryngeal sensory neuron was unipolar. CGRP-reacted laryngeal sensory cells were found in the rostral part of the nodose ganglion extending to the middle part. They aggregated in the most rostral part, were sparse in other parts and were approximately 50 per cent of WGA-reactive laryngeal sensory neurons in number. Our results suggest that this neurotransmitter might play an important role in laryngeal peripheral sensory innervation.

A retrospective analysis of thirty patients with external laryngeal trauma was performed to assess the type and extent of injuries commonly seen as well as the outcome following treatment. Outcome was assessed both in terms of voice and airway. Major laryngeal injuries (19 cases) outnumbered minor injuries (11 cases). A good correlation exists between the symptoms of haemoptysis and stridor at presentation and severity of the injury (p = 0.002). Early surgical intervention is associated with better outcome (p = 0.01). However there is no statistically significant difference in outcome between major and minor injuries (p = 0.3) indicating that other factors are operative in determining outcome. Based on our findings a management strategy for patients with external laryngeal trauma is outlined.

Abstract: Retrospective analysis of detailed patient and tumour factors associated with a complete response to combination inductive chemotherapy with CDDP-5FU (96 or 120 hour continuous infusion) was performed using data from 147 patients with a previously untreated squamous cell carcinoma of the oral cavity, oropharynx or pharyngo-larynx following completion of two (29 patients) or three (118 patients) cycles. Adverse reactions to chemotherapy were documented for all 164 patients included in the study. Eight drug-related deaths occurred due to: acute myocardial infarction (five patients), peptic ulcer disease (two patients) and severe neutropenia with sepsis (one patient). Severe non-lethal complications included marrow depletion (14 patients), peptic ulcer (two patients), thrombophlebitis (seven patients), angina pectoris (two patients), stroke (one patient), pulmonary oedema (one patient) and convulsions (one patient). Six patients refused further treatment because of untoward side effects and tumoral progression was observed in three cases. Separate response rates for the primary site and nodes were determined and analysis of respective predictive factors of response was performed. Complete response was obtained in 31 per cent at the primary site versus 18 per cent for the nodes (p<0.05). The combined (primary site + nodes) overall complete response rate was 22 per cent. Among 11 factors studied (age, sex, performance status, primary site, tumour differentiation, initial resectability, 5FU dosage per cycle, number of cycles, T, N and TN stages), only performance status, N stage, resectability and number of cycles were associated with a combined complete response. Multivariate analysis showed performance status, N stage, TN stage and resectability to be significant predictive factors of a combined complete response. Optimum use of inductive chemotherapy will ultimately rely upon a better knowledge of predictive factors in order to avoid drug-related complications in patients not expected to respond.

A rare case of a congenital fistula of the stapes footplate, in a 10-year-old girl, resulting in recurrent meningitis, is reported. A full ENT examination and a high index of suspicion, is essential if the diagnosis is to be made.

Exploratory tympanotomy should be considered on clinical grounds, even if a high resolution CT scan of the temporal bones does not show any anomalies, in order to ascertain the definite diagnosis of a fistula and to seal it permanently.

Abstract: Metastases to the temporal bone are a recognized, if rare, cause of otological symptoms including sudden sensorineural hearing loss. Carcinoma of the prostate is a common cancer which frequently metastasizes to bone but is only rarely reported in the temporal bone. We report a case of sudden sensorineural hearing loss due to metastatic prostatic carcinoma in the temporal bone.

Isolated osteomata of the external auditory canal are benign and often symptomless lesions, and are distinct from the much commoner exostoses. A case is reported in which an osteoma presented as a recurrent ‘aural polyp’ due to a fibroepithelial polypoid reaction in the overlying skin. The polyp and the osteoma were excised surgically. We believe this to be the first reported case to present in this manner.

A case is described of a primary cerebral lymphoma which presented with bilateral cerebellopontine angle lesions. No similar case has been reported in the English language in the last 25 years. The literature is reviewed and discussed.

Granular cell tumour is a rare benign neoplasm, that can affect many parts of the body, as single or multiple lesions. It is more common in black people and females. Typically it occurs between the fourth and fifth decades of life, with the median age for the laryngeal variety as 36 years. About 30 to 50 per cent occur in the tongue and 30 per cent in the skin.

A case of granular cell tumour of the larynx is reported in an eight-year-old girl, presenting with hoarseness of voice. She was successfully treated with local excision of the tumour. This tumour is rare in the larynx where it is more common in males than females although granular cell tumours are found more frequently in females generally.

For these reasons the authors suspect that their case, of a laryngeal granular cell tumour occurring in an eight-year-old girl might be the youngest to be reported.

Chordomas are rare tumours which arise from notochordal remnants. A primary cervical chordoma of extranotochordal origin, sparing osseous structures, was excised by a bilateral neck dissection. The patient was disease-free two and a half years later.

Since it was first described, the original percutaneous endoscopic gastrostomy (PEG) technique has proved to be a valuable adjunct in patients with head and neck tumours. This procedure is being increasingly utilized in the face of swallowing impairment related to head and neck carcinoma. Although generally well tolerated, it may be associated with complications. In this report, we document tumour implantation at the percutaneous endoscopic gastric site and review the report cases. It appears that implantation metastasis does alter prognosis.

Cystic lesions of the thymus are rare. In a large series of over 200 mediastinal cysts only 12 cases of thymic cysts have been reported (Seltzer et al., 1968). Cervical thymic cysts are so rare that only 35 cases have been documented in the English literature. (Al-Shihabi and Jackson, 1982).