The knowledge of the Byzantine physicians in the field of otorhinolaryngology and especially of the eminent ones, Oribasius, Aetius of Ameda, Paul of Aegina and Alexander of Tralles is noteworthy. They knew an adequate number of diseases of the ear, nose and throat and treated them with a plethora of drugs and some of them, especially tonsillitis and tonsillar abscess, with operations. The writer, based on the texts of the Byzantine historians and chroniclers, presents information previously unknown. This includes analysis of cases of an epidemic of angina, speech defects, instances of otitis, epistaxis, ulcer of the mouth, acute laryngitis or pharyngitis and psychogenic aphonia. Most cases concern emperors and other prominent figures of the State and Church. This information complements, from the historical point of view, the scientific knowledge of the medical writersin the field of otorhinolaryngology.

The possible involvement of depression on cellular immunity in reactivation of varicella-zoster virus (VZV) in herpes zoster oticus was investigated. The subjects comprised 59 cases of herpes zoster oticus, 33 cases of herpes zoster sine herpete (ZSH) with facial paralysis, and 205 cases of Bell's palsy. The transformation rate of lymphocytes to phytohaemagglutinin in herpes zoster oticus tended to be lower than that in Bell's palsy. In skin tests with purified protein derivatives of tuberculin, the positivity rate in herpes zoster oticus was significantly lower than that in Bell's palsy (p<0.015). In skin tests using VZV antigen, the positivity rate in herpes zoster oticus and ZSH were significantly lower than that of Bell's palsy (p<0.001 and p<0.015, respectively). Thus, it was noted that cellular immunity, especially specific cellular immunity against VZV, was significantly depressed in herpes zoster oticus and ZSH. We consider that depression of specific cellular immunity plays an important role in triggering reactivation of VZV and onset of these diseases.

The case notes of 34 patients undergoing rehabilitative facial nerve surgery between 1978 and 1994 were retrospectively examined. Thirteen patients underwent facio-hypoglossal transposition with six achieving a facial nerve grade of IV (House-Brackmann scale) at 24 months post-surgery. Twelve patients underwent cable grafting of the facial nerve defect. Of these, 10 achieved a grade III result at 24 months. Nine patients underwent end to end anastomosis of the facial nerve, seven achieving a grade III result at 24 months after the repair. Re-routing of the facial nerve and the use of tissue glue to effect the anastomosis did not have an adverse effect on the outcome. Comparison of rerouted end to end anastomosis with non-re-routed cable grafting showed no difference. Patients presenting pre-operatively with facial weakness and those in whom nerve repair surgery was delayed for more than six months were less likely to have a good result.

Antral washouts have been widely used in the management of chronic sinusitis. With the advent of modern antibiotics and powerful topical nasal steroids, we sought to establish if a role remains for this procedure.

One hundred and fourteen patients with chronic sinusitis were randomised into two groups. Patients in Group A received antral washouts followed by antibiotics and topical nasal steroids. Patients in the Group B received antibiotics and topical nasal steroids alone. In each group 51.6 percent and 50 per cent of patients respectively improved with treatment. The outcome of treatment is also not influenced by endoscopic abnormality. The difference was not statistically significant (p = 0.86). The study indicates that half of patients with chronic sinusitis will improve with medical treatment but the addition of antral washout confers no additional benefits.

The aim of the study was to compare the numbers and distribution of mast cells in the nasal mucosa of perennial allergic rhinitis (PAR) patients and controls, as demonstrated by different staining methods for light microscopy.

Biopsies of inferior turbinate mucosa were taken from 10 patients with PAR and 10 patients undergoing septoplasty or septorhinoplasty (control group). Sections for light microscopy were stained with azure A, chloroacetate esterase and an ABC immunohistochemical technique using antibody to tryptase.

Three times more mast cells were found in the epithelium of PAR patients compared to controls using the immunohistochemical technique (p = 0.0074). This method demonstrated considerably more mast cells than the other stains.

The increase in epithelial mast cells is consistent with the migration of mast cells seen in seasonal allergic rhinitis, and this may be important in the phenomenon of nasal priming seen after repeated antigen exposure.

During the period 1976–1988, 988 patients were treated surgically for laryngeal cancer of whom 61 were below the age of 40 years.

In 29 patients the tumour was localized in the supraglottis, and in 32 in the glottis. T1 tumour was present in 32 (52.46 per cent), and T2 tumour in six (9.84 percent) patients. Advanced T3 and T4 tumours were present in 13 (21.31 per cent), and (16.39 per cent) patients respectively. The majority had clinically negative findings in the neck (N0). Conservative or reconstructive surgery was applied in 39 (63.93 per cent), and radical in 22 (36.07 per cent) patients. Planned post-operative radiotherapy was carried out in 28 (45. 90 per cent) patients.

The five-year survival rate of the studied patients was 83.61 per cent (51/61). The five-year survival rate of the patients with laryngeal carcinomas within the same period was 68.32 per cent (675/988). There was no significant difference in survival rate: X2 = 0.018, DF = 1, p>0.05.

The radical neck dissection specimens of 384 ethnically Chinese patients with different primary squamous carcinomas in the head and neck region were studied. Over 50 per cent of the specimens showed metastatic disease at one level in the neck. For oral cavity carcinoma, the levels of metastasis frequently involved were I, II and III while for carcinoma of the oropharynx, hypopharynx and larynx, the levels were II, III and IV. Extracapsular spread was present in 112/384 of patients (29 per cent) and this increased with advancing N-stages. Based on these findings, different selective neck dissections could be used for patients harbouring different primary head and neck carcinomas with limited neck disease.

An in vivo study was performed to evaluate the use of pulsed-dye laser beam for the fragmentation of salivary calculus. In accordance with the absorption and reflection spectra of sections of salivary stones, optimal fragmentation was achieved with a pulsed-dye laser with a pulse width of 1.4 μm and tuned to a wavelength of 504 nm. Further studies on particle size were conducted, and a new “sialoendoscope” technique was developed. Fifteen patients with sialolithiasis of the submandibular gland were treated. Under continuous endoscopic monitoring laser-induced shock wave lithotripsy was performed. In six patients complete fragmentation and removal of the salivary stones was achieved and in another patient 50 per cent fragmentation was sufficient to restore salivary flow. Laser lithotripsy of salivary stones with endoscopic monitoring permits treatment on an outpatient basis with little inconvenience to the patient, and this is a breakthrough in otolaryngology.

Inherited bleeding disorders are frequently considered an absolute contraindication to tonsillectomy and other ENT procedures. Over a 15-year period we have performed ten elective tonsillectomies and five bilateral myringotomies on children with inherited bleeding disorders. All procedures were carried out with the close co-operation of the Haematology Department in the hospital. All patients underwent uneventful surgery. One patient returned after tonsillectomy with a secondary haemorrhage which did not require surgical intervention. We present our team approach to the management of these children and demonstrate that necessary surgical intervention can be undertaken safely in this select group of patients.

A simple, safe and effective procedure for improving the bacterial isolation in chronic suppurative otitis media (CSOM) is described. It is most useful for the isolation of aerobes as well as anaerobes from the middle ear.

A three-generation family with Saethre-Chotzen syndrome and an isolated case are presented. The proband presented with conductive hearing loss. His mother and grandmother showed minor features of the syndrome including conductive hearing loss.

Symptoms of the craniosynostosis syndromes can include stapes ankylosis, a fixed ossicular chain in a too small epitympanum, and small or even absent mastoids. The proband was treated with a boneanchored hearing aid (BAHA) instead of reconstructive middle ear surgery. Current literature on the results of ear surgery is reviewed. In general, reconstructive middle ear surgery should only be considered if congenital anomalies of the middle ear are the only presenting symptom. In cases with additional anomalies such as atresia of the ear canal or damage due to chronic ear infections, the outcome of reconstructive surgery to correct the anomalous ossicular chain is unsatisfactory. In such cases the BAHA is probably the best solution.

Cochlear implantation is now a routine clinical procedure for deaf patients in many countries (Gibson, 1987). It replaces the function of damaged cochlear hair cells and, therefore, detects sound and by electrical stimulation produces an appropriate signal in the remaining cochlear nerve fibres (House and Berliner, 1991). Wegener's granulomatosis is an uncommon auto-immune disease. It has a peak incidence at the fifth decade with slight male predominance. Nasal problems are the predominant presentation with otological manifestations presenting rarely. We report a case of Wegener's granulomatosis presenting with total hearing loss and after right cochlear implantation a free field threshold of 40 dB and 20 per cent Bamford-Kowal-Bench (BKB) speech test.

We conclude that Wegener's granulomatosis is not an absolute contraindication for cochlear implantation.

A case of angiofibroma limited to the right posterior nasal cavity, nasopharynx, and pterygopalatine fossa was operated upon transnasally under endoscopic control. The tumour was completely excised without complications. Endoscopic follow-up for the next two years and contrast computed tomography (CT) excluded any residual tumour or recurrence. The advantages, limitations and possible complications of this approach are discussed. It seems that in limited lesions of angiofibroma, the option of a transnasal endoscopic approach could be cautiously considered by experienced surgeons.

Laryngeal lymphangiomas are uncommon and virtually always represent extension of cervical disease. The exceptionally rare lymphangioma that remains isolated to the larynx has been reported only twice prior to this case.

A six-month male infant presented with an undiagnosed mass in the supraglottis which had caused respiratory compromise requiring a tracheostomy. The diagnosis was made histologically and the treatment was begun. Therapy consisted of staged laser resections carried out cautiously to preserve laryngeal competence. After three laser treatments the lesion was controlled and the patient prepared for decannulation. This interesting case is presented with a review of the literature.

The case histories are presented of three patients with circumferential subglottic stenoses who presented, over a six-month period, to a teaching hospital's Otolaryngology department. No recognisable cause for their subglottic stenoses was found. Traumatic, iatrogenic, infectious and specific inflammatory processes were excluded. The histopathological evidence suggested a chronic inflammatory process. All patients were treated by resecting the stenosis with a carbon dioxide laser. One patient required an emergency tracheostomy for airway obstruction. A review of the published literature on this rare condition is given.

Tuberculosis of the parotid gland is rare. It cannot be distinguished from a parotid tumour by clinical examination alone, so surgical exploration has usually been required for diagnosis. We present a case with the same diagnostic dilemma.

Hydatid disease is caused by the parasitic tapeworm Echinococcus. This parasite in larval stage can thrive in many parts of the body, most commonly in the liver and the lung. Hydatid disease in the head and neck region is rare. An unusual location for hydatid disease in the pterygopalatine fossa-infratemporal fossa is presented. The patient did not have evidence of any other cyst on a ten-year follow-up.

Otolaryngological manifestations of factitious disorders are rare. The case of a health care worker who injected her face and orbits with air in order to masquerade as facial cellulitis is presented. The literature and treatment strategies are reviewed.

The position and dimensions of the jugular bulb and the venous dural sinuses vary considerably. While the anatomical variations of the jugular bulb have been extensively reported in the literature, that of the sigmoid sinus have been reported only rarely. We report a case of unusual anterior course of the vertical segment of the sigmoid sinus which was encountered during an attempted myringoplasty. Anomalies of the jugular bulb in general are also described.

Nasopharyngeal carcinoma (NPC) may spread posterolaterally with infiltration of the jugular foramen, jugular vein and the cranial nerves IX-XI. Cranial nerve palsies may be evident clinically but the extent of skull base infiltration is best assessed radiologically. Denervation atrophy is well demonstrated by both magnetic resonance imaging (MRI) and computed tomography (CT). Accurate delineation of the lesion is important in prognosis and radiotherapy planning.