In 1861 Prosper Menière separated patients with episodic vertigo, hearing loss and tinnitus from a group previously described as having apoplectiform cerebral congestion. He suggested the cause was disease within the semicircular canals (Menière, 1861). Over the years it becoame apparent that within this group there were a number of patients with characteristic signs and symptoms and in 1938 a pathological correlate was found in the form of endolympatic hydrops. Descriptions scuh as Menière's ‘Menière's ‘disease’, Menière's ‘syndrome’ and Menière' ‘symptom complex’ led to a confusing array of terms for this condition and monotoring of treatment results became difficult. In response to this in 1972 the American Academy of Ophthalmology and Otolaryngology and Otolaryngoly Committee on Hearing and Equillibrium published a clear definition of Menière's disease and criteria for the reporting of treatment results, it was updated in 1985 and again in 1995. We described the changes that have taken place as the definition of Menière's disease has evolved.

Examination of disease patterns in the past has often been difficult due to lack of morphological evidence. This study presents a new unbiased method estimation of occurences of infectioous middle ear disease (IMED) in childhood. The method is based on the relation between IMED in childhood and small or asymmetric pneumatized cell areas in the temporal bones as seen on standrdised X-rays.

A Polychotomous logitic regression mofel was applied on 434 pneumatized cell areas in temporal bones from 34 adult living Greenlandic Inuit, 56 adult crania from the 18th to the 19th century A. D. and 127 adult inuit crania from the Pre-European colonization period (before A. D. 1721) of Greenland. The occurence of IMED as designated by the model was eight out of 34 (23.5 per cent) in living Inuit, 10 out of 56 (17.9 per cent) in crania form the 18th to 19th century and six out of 127 (4.7 per cent) in crania form the pre/colonization period. These frequencies differed significantly (p<0.002). The mean area size also differed significantly, thus indicating a change in occurence of IMED and a decrease in area sizes from past to presentin Greenland.

Ninety-three patients with histolofically or radiolofically confiemd unilateral vestibular schwannomas were recruited. Audiological testing for retrocochelar pathology was undertaken. Patients' hospital records were examined for previous audiological and radiological results.

The audiometric configuration was designated as one of the following normal, sloping, low frequency, peak, through or falt. A sloping sensorneural audiometric configuration was present in 68 pec cent of cases. No significant correlation was found between tumour size and average pure tone threshold 500 HZ to 4000 HZ, optimum discrimination score or interaural differences for wave V. Ninety-one per cent of cases had abnoramalities on auditory evoked potential; 92 per cent of cases showed abnormalities on stapedial reflex testing.

The limitations of audiologica testing in the investigation of patients with suspected unilateral vestibular schwannomas are discussed. A protocol for the investigation of such patients is presented.

Magnetic resonance imaging (MRI) is the imaging modality of choice in diagnosing vestibular schwannoma (VS). Perceived high costs have prevented clinicians from using it as a screening investigation, although MR scanners are now widely available in the United Kingdon. In a retrospective study, the clinical records of all the patients who presented to the ENT department of Taunton and Someerset NHS Trust with suspected symptoms of VS during the year 1994 were analysed. The cost of confirming or refuting the diagnosis of VS in each patient ranged from £220.72 to £580.31 depending on the number of hospital visits and investigations performed. This study shows that the routine use of MR scanning for detection of VS is cost effective and more effective than the use of conventional tests.

Vestibular larobatory tests are not general necessary in the diagnosis of patients with a clear description of vertigo accompanied by positive otoneurological examination findings. The purpose of the study was to inverstigate the role of conventional vestibular laboratory tests in the diagnosis of patients compaining of hnonspecific vertigo, despite their having a documented normal otoneurological examination. The results patients referred for ambulatory vestibular laroratory testes due to a nonspecific illusion of movement, but with nornal otoneurological examination, were reviewed. Abnormalities were found in the vestibular tests of 35 patients (67 per cent), 22 of whom (63 per cent) were finally diagnosed as having a unilateral perpheral vestibular lesion, and 13(37 per cent) benign positional vertigo. These results suggests that a high percentage of patients with nonspecific vertigo and a normal otoneurologica examination probably suffer from peripheral vestibular dusfunction, which can be objectively documented by the ENG and SHA tests.

In the disecribed study, 26 patients after conventional, and 27 patients after laser cordectomy were examined six months or more after the operation. Videolarybogstroboscopy revealed that patients after laser cordectomy more often phonate on a purely glottic level (81 per cent) in comparison to patienbts after conventional cordectomy (19 per cent). Webs were more frequent and more extended after conventional cordectomy compared to endoscopic laser surgery. The maximal phonation time showed a very wide range with a mean value of 9 to 10 sec; there was no statistical difference between the groups of patients. Using yanagihara's classification of sonograms, a better voice quality was measured after laser cordectomy than conventional cordectomy. The patients' estimation of their voice quality did not correlate with objective parameters.

Seven of the most commonly used tracheostomy tubes used in the UK were tested for cuff herniation and creasing in synthetic tracheas corresponding to the shapes and sizes found in vivo. Results demonstrated that only two tubes of one particular brand herniated and that creasing occured in tubes disproportionaltely large for the trachea used. A discussion of modern tracheostomy tube manufacture is included.

The authores report a case of patient with pachyonychia syndrome, a rare genedermatosis inherited as an autosomal dominant trait, who also had otological lesions beyond the other classic signs and symptoms of the syndrome. Many kinds of treatment have already been proposed, but all failed to show satisfactory results. A new, cheap and easy-to-use treatment was developed in this study, using keratoplastics interpolated with humectant lotion for 90 days. The results after three years of follow-up are still thoroughly satisfactory.

Whilst the oral contraceptive pill (OC) has been implicated on a number oif occasions as a cause of sensorineural hearing loss, there are no published reports linking hormone replacement therapy (HRT) to otological symptoms. A case of sensorineural loss with tinnitus following commencement of HRT is described, followed by a discussion outlining the fundamental differences between the OC and HRT, thus expaining why a vascular aetiology is unlikely. It is hypothesized that otological symptoms in such cases may be due to the effect of oestrogens on electrolyte balance disturbing inner ear function and also a direct effect on the auditory pathways mediated in part by alterations in neurotransmitter receptor concentrations.

Superficial siderosis is a rare central nervous system disorder characterized by deafness, ataxia, and pyramidal signs. The hearing loss is believed to be predominantly neural and is usuallly progressive and bilateral. Careful assessment is therefore necessary to determine the best approach to hearing rehabilitation. A case is presented of usperficial siderosis in a young woman who has benegited significantly from cochlear implantation using the Nucleus dvice.

Two cases of rhinoenetomophthoromycosis are presented. This rare disease can prodice progressive deformity of the nose and facial structures. A review of the clinical symptoms along with its diagnosis and treatment is described.

The clinicopathological features of two unusual cystic lesions, one arising in the nose, a calcified mucocoele or a calcified retention cyst and the other in the maxillary sinus a dentigerous cyst originating in a supernumerary tooth, are described. The literature on these two rare lesions is briefly reviewed.

Neural-crest tumours, including neuroblastomas, express somatostatin receptors. This can be shown by radionuclide labelling of octreotide, a somatostatin analogue. Studies on imaging with this substance have dealt with childhood neuroblastomas. Olfactory neuroblastoma (aesthesioneuroblastoma) is a rare tumour in which somatostatin receptor content has not been analysed, nor have radionuclide methods for diagnostic purposes been described. We report a case of olfactory neuroblastoma, in which scanning with m In-labelled octreotide was performed. A strong uptake was seen at the base of the skull. This was confirmed as a recurrent tumour by magnetic resonance (MR) imaging. Uptake was also observed in the neck and chest, indicating extensive spread of the disease.

Somatostatin receptor expression has been shown to correlate with prognosis in childhood neuroblastoma. The accuracy of labelled octreotide in the diagnosis of olfactory neuroblastoma indicates that it might be useful in radionuclide therapy of patients with advanced disease, when no other treatment modalities are available.

Inhalation of a foreign body is a serious event. A small proportion of foreign bodies become impacted in the larynx, when urgent recognition is required to prevent disaster. The case of an 18-month-old baby with an impacted artificial finger nail in the larynx is described along with a brief review of the literature

Internal jugular vein thrombosis is an uncommon potentially life-threatening disorder caused by various conditions. Non-spontaneous internal jugular vein thrombosis is an uncommon condition associated in the preantibiotic area with deep-neck infections. Currently iatrogenic trauma to the internal jugular vein from catheterisation and repeated intravenous injections by drug abusers are the leading causes of thrombosis. Spontaneous internal jugular vein thrombosis may occur when there are no apparent pre-disposing mechanical or inflammatory causes although a few of these patients may harbour an occult malignant neoplasm. Hence, careful investigation and follow-up are vital. Thrombosis in Trousseau's syndrome is usually confined to the vascular system of the extremities and the viscera. However, secondary to the paraneoplastic hypercoagulable state, thrombosis can occur in the large veins of the head and neck region. We understand this to be the first case where spontaneous internal jugular vein thrombosis and ipsilateral recurrent laryngeal nerve paralysis were the only initial manifestations of an occult malignancy.

Neoplasms of the facial nerve presenting as a parotid mass are uncommon. In the absence of a facial palsy their origin from the nerve is usually diagnosed intraoperatively. The majority of these neurogenic neoplasms are schwannomas, with neurofibromas occurring rarely. Although the Schwann cell is the key element in both, they have distinct histopathological characteristics, and their clinical course and management often differs. The first reported case of an intraparotid facial nerve schwannoma in a child in the English literature is presented.

The anatomical location and relationships of the submandibular gland are well-known to most otolaryngologists and gross variations from the norm are rare. We report a case of an atypical submandibular gland located 2 cm below the mandible which presented as a painful neck swelling with non-diagnostic fine needle aspiration cytology. Using Doppler ultrasound the mass was noted to be closely located to the facial artery and vein and following the administration of oral lemon juice, the peak systolic velocity of a small artery within the mass rose from 8.5 cm/s to 16.4 cm/s, confirming the tissue's salivary nature. We review the literature on using Doppler ultrasound in this area of the neck and discuss realistic practical applications of the technique.

Neurofibroma affecting the major salivary gland is uncommon. This tumour is particularly rare in the submandibular and sublingual gland.

Here, a case of solitary plexiform neurofibroma of the submandibular gland without any other manifestations of von Recklinghausen's disease is presented. It is probably the first case report of this tumour invading the submandibular gland in a solitary form.