Despite good evidence to the contrary, the Spanish singing teacher Manuel Garcia is still credited by many to have been the discoverer of the mirror for inspecting the larynx. Although the adoption of this technique into clinical practice, and thus the beginning of laryngology as a specific discipline, is rightly credited to others Manuel Garcia achieved unwarranted fame…if not fortune. Careful examination of the published literature has substantiated the claim that 26 years prior to the paper presented on Garcia's behalf to the Royal Society of London, Babington had described to the Hunterian Society a similar device which later evidence indicated had been used clinically on at least one laryngologist. This claim was also supported by no less than Morell Mackenzie in a published lecture in 1864, nine years after Garcia's lecture. Possible explanations for this aberration of justice are considered.

Purpose The purpose of this study was to investigate the outcome of different injuries to the facial nerve.

Materials and methods Six patterns of injuries (exposure, compression, crushing, stretching, division and post-division anastomosis) were produced in the buccal branches of the facial nerve in 60 rabbits. Electroneuronography (ENoG) and histology at definite time were used to evaluate the results.

Results and conclusions Exposure and compression injuries produced a neuropraxic injury and rapid recovery. Crushing and stretching injuries resulted in axonotmesis and whilst complete recovery can take place it may be very slow. Division and post-division anastomosis fall into neurotmesis injury and do not completely recover within six months; the former recovers slower and later than the latter.

Botulinum toxin type A (BTA) is known to inhibit the release of acetylcholine from cholinergic nerve endings. Owing to the characteristics of BTA, we thought that it could be used for the treatment of intrinsic rhinitis acting as an anticholinergic drug. In a double-blind placebo-controlled study four units of BTA were injected into the middle turbinate (two units) and inferior turbinate (two units) in each nasal cavity. Rhinorrhoea, nasal obstruction, and sneezing were recorded in a symptom diary on the basis of a scale of 5 and the number of paper tissues used per day was also recorded for 24 weeks. Rhinorrhoea was significantly diminished in severity (24.1–41.5 per cent reduction) and paper tissue use (54.3 per cent reduction) in the BTA group compared with the placebo group. This effect could be maintained for four weeks. Sneezing and nasal stuffiness were not affected by BTA. These results suggest that BTA can be used to treat rhinorrhoea in intrinsic rhinitis patients, however, the effective period is short.

Synchronous or metachronous second primary malignancies of the lung are sometimes encountered in patients with laryngeal cancer while the occurrence of a laryngeal second primary following cancer of the lung is rare.

A two-armed study was conducted. A prospective arm in which the larynges of 56 terminal lung cancer patients were examined, and a retrospective arm incorporating both a chart study of 126 terminal head and neck cancer patients (HNCP) and a computerized search of all hospital records of patients with laryngeal and lung cancers. No laryngeal malignancy was found in the lung cancer patients' group and no antedating pulmonary malignancy was recorded in the terminal HNCP. The computerized search of 1778 lung cancer patients and 213 laryngeal cancer patients also failed to demonstrate cases where the former preceded the latter.

In conclusion. No second primary of the larynx was found in lung cancer patients. These results compare with reports of large databases where cancer of the larynx was found in a negligible percentage of lung cancer survivors and theories explaining this are discussed.

This paper focuses upon the quality of the Dutch translation of the STSS (Subjective Tinnitus Severity Scale), a scale which assesses the severity of tinnitus and the related distress. Research has been done on the psychometric qualities of this scale, its relationship with loudness-matching procedures and several psychological variables. Data presented on 104 tinnitus patients demonstrated the reliability of the STSS with a coefficient alpha of 0.71. Factor analysis revealed four factors: emotional distress, intrusiveness, annoyance and cognitive distress. With regard to the validity, significant correlations of a moderate degree were found with several unitary subjective scales measuring the same construct (rs = 0.50, p<0.001 and rs = 0.43, p<0.01). Correlational research demonstrated that the STSS is independent of the loudness of tinnitus as measured by matching procedures (rs = 0.00).

In contrast, significant correlations of a moderate magnitude were found with anxiety (rs = 0.33, p<0.001) and depression (rs = 0.31, p<0.01 and rs = 0.35, p<0.001).

The microbiology of 87 patients admitted to hospital, over a five-year period, with acute sinusitis was retrospectively analysed. Sixty-three patients had one or more of an orbital, intracranial, soft tissue or bony complication. Eighty-four patients had maxillary sinus washouts, while 48 required a surgical procedure to their sinuses, and 33, drainage of an empyema. Streptococcus milleri and Haemophilus influenzae were the commonest organisms isolated from sinus aspirates (44 per cent), with a noticeable absence of Streptococcus pneumoniae (10 per cent). Organisms cultured from intracranial, soft tissue or orbitral empyemas were predominantly Streptococcus milleri (50 per cent) and Staphylococcus aureus (25 per cent) with an absence of Haemophilus influenzae (four per cent) and Streptococcus pneumoniae (four per cent). Ampicillin is an appropriate first line antimicrobial agent in patients with acute complicated sinusitis with the addition of cloxacillin in cases with an empyema. Chloramphenicol or ceftriaxone is used in cases with an intracranial complication.

Excision of the submandibular gland is a surgical procedure often undertaken. The procedure is the treatment of choice for patients with neoplasm of the submandibular gland and those with non-neoplastic submandibular disorders which are not controlled with conservative medical measures. Extirpation of the submandibular gland may also be undertaken for diagnostic purposes.

This retrospective study of 93 consecutive patients who underwent excision of the submandibular gland in the Department of Otolaryngology, Singapore General Hospital over a five-year period was undertaken to study the indications of surgery, the pathology of the excised submandibular gland and the demographic profile of patients.

Fifty-six (60.2 per cent) patients underwent submandibular gland excision for non-neoplastic salivary gland disease while 37 (39.8 per cent) had neoplastic submandibular gland disorders. The commonest pathology encountered was sialadenitis/sialolithiasis (53.76 per cent) followed by pleomorphic adenoma (33.33 per cent). Fine needle aspiration cytology (FNAC) was a valuable pre-operative investigation with a sensitivity and specificity of 94.7 per cent and 100 per cent respectively for neoplastic diseases. The morbidity rate for this surgery was 4.3 per cent.

Malignant otitis externa is a serious condition that presents difficulties in treatment, and also in monitoring its progress. A case of malignant otitis externa with optic neuritis is presented that remained refractory to standard treatment but was cured by adjuvant hyperbaric oxygen therapy. This is the only reported case that has survived this disease with optic neuritis. The usefulness of imaging techniques in this condition is discussed, as well as the ESR, in evaluating the effectiveness of treatment.

Chondroma, a benign tumour which is common at many sites in the body, has not been reported in the English literature in the bony external auditory canal. The first such case at this anatomical site is described and the pathogenesis is considered.

Kaposi's sarcoma (KS) is a neoplastic vascular disorder characterized by multiple reddish blue nodules which, according to the original description (Kaposi, 1872), usually present on the skin of the upper and lower extremities. It is not until the disease progresses that nodules appear on the skin of the head and neck, on mucosal membranes and as visceral lesions. However, with the large increase in the incidence of this tumour associated with the acquired immune deficiency syndrome (AIDS) epidemic, there have been increasing numbers of cases of Kaposi's sarcoma presenting primarily on the skin or mucosa of the head and neck. The most common sites reported are within the oral cavity, particularly on the palate. Other mucosal sites are rare. We present an unusual case where the primary manifestation of the Kaposi's sarcoma was in the nasal mucosa and stress the importance of this diagnosis not being overlooked.

We report a case of an antral mucocoele secondary to the obstruction of its ostium by metastatic endometrial carcinoma. This is the first report of such a cause for a mucocoele, and for a metastasis from such a tumour in the head and neck.

Solitary fibrous tumour is a particular kind of mesenchymal tumour, classically arising in the pleura. We report the first case arising in the larynx, associated with a metastasizing adenocarcinoma. The diagnosis is mainly histopathological, especially when strong immunoreactivity for the CD34 antibody is present.

We encountered a 59-year-old man with angiomyoma of the retropharyngeal space. He had been referred to our hospital because of a six-month history of a sensation of a narrowed pharynx. A smooth-surfaced tumour arising from the posterior wall in the hypopharynx was observed by indirect laryngoscopy. Radiographical imaging revealed a solitary tumour with homogenous contents in the retropharyngeal space. The tumour was successfully removed via a lateral pharyngotomy approach under general anaesthesia. Histopathologically, the tumour was composed of numerous veins with thick muscular walls. To the best of our knowledge, this is the first report of an angiomyoma arising in the retropharyngeal space.

Benign chondroma affecting the soft tissues is uncommon. This tumour is particularly rare in the neck. We present the first case of soft tissue chondroma arising in the parapharyngeal space of a 20-year-old man with a two-year history of a gradual sensation of a swelling in the pharynx with increasing snoring. The CT and pathological features of this lesion will be discussed. We suggest that a peroral approach should be considered for benign parapharyngeal tumour which has been demonstrated on imaging to be in the anterior parapharyngeal space, especially for tumours that are medial to the pterygoid muscles even though the tumour is a large one.

Abscesses of the pterygopalatine fossa are extremely rare. The cases reported in the literature are all secondary to dental or periodontal disease. We present a case of an abscess in this site which was a complication of chemotherapy and was the result of haematogenous spread.

Two cases of cervical necrotizing fasciitis are presented. Both are unusual in that they had had radiotherapy for head and neck malignancy six and 14 years previously with no evidence of tumour recurrence. One case of necrotizing fasciitis has previously been cited in the literature associated with radiotherapy (Krespi et al., 1981). The two cases are discussed along with a review of the literature.

We report a case of a 36-year-old woman who suffered a temporal bone trauma due to a bicycle crash. Computed tomography revealed parapharyngeal emphysema despite only minor temporal bone changes.

The assessment of head and neck cancer has traditionally involved clinical examination and anatomical imaging by computed tomography (CT) or magnetic resonance imaging (MRI). We present a case where a problem of clinical confusion and inconclusive radiology was resolved by the use of positron emission tomography (PET) coregistered with CT.