We present a rare case of perilymphatic fistula which occurred due to bony erosion by a tympanostomy tube that had migrated into and become interred in the middle-ear space.

We present a case report and a literature review concerning migration of tympanostomy tubes into the middle ear as a complication of tubes insertion.

Medial migration of tympanostomy tubes into the middle-ear space is a rare complication of tympanostomy tubes insertion. To our knowledge, this is the first report of perilymphatic fistula caused by a tympanostomy tube which had migrated into the middle ear. This case highlights the need for early removal of tympanostomy tubes which migrate into the middle ear.

We report a rare case of auricular involvement by leishmaniasis, in order to demonstrate the importance of thorough investigation of cutaneous head and neck lesions, and also the importance of inclusion of infections such as leishmaniasis in the differential diagnosis of auricular lesions, especially in endemic areas.

A 42-year-old man with multiple lesions on his head, neck and hands was referred to our centre. He had the following lesions: a painful, crusted, 8 × 8 cm plaque with indurated margins on the left parotid region and auricle; a red papule on the right temporal region; an ulcerative lesion on the skin overlying the proximal interphalangeal joint of the fifth finger of the right hand; and a bluish papule on the neck. Although histopathological examination of the Geimsa-stained specimen was misleading, a direct smear prepared from biopsies showed amastigotes, and therapy resulted in complete recovery.

Leishmaniasis can be both under- or over-diagnosed. Especially in endemic areas, parasitic causes of chronic infections should always be kept in mind.

Peritonsillar abscess (quinsy) is one of the most common ENT emergencies. A 2002 UK audit of quinsy management revealed that an average ENT department treated 29 cases annually; the most common treatment was needle aspiration with intravenous antibiotics, and culture of the aspirate was often performed routinely. The aims of our study were to evaluate the value of routine culture of quinsy aspirates, and to establish whether the information thus gained was clinically useful.

We examined the notes of patients admitted with quinsy to two hospitals in south-west England, from January 1998 to January 2004 in one hospital and from January 1995 to January 2005 in the other. A total of 577 cases was found. Aspirated pus had been sent for culture in 119 (21 per cent). These cases were examined in more detail.

Of the 119 patients, 78.2 per cent (93/119) were treated with either a cephalosporin or penicillin, plus metronidazole. Streptococcal species were cultured in 43.7 per cent (52/119) and anaerobes in 23.5 per cent (28/119; of these cultures, 5.9 per cent (7/119) were pure anaerobes only). All the anaerobes were sensitive to metronidazole. One of the 119 cultures, growing aerobic bacteria, was resistant to penicillin; however, this patient improved clinically on a combination of penicillin and metronidazole. No patients had their treatment changed because of culture results.

There appears to be no need to routinely culture quinsy aspirates, based upon our findings (of 16 hospital years) and previous studies (which found no recorded episodes of treatment change as a result of culture sensitivities). The combination of penicillin or a cephalosporin, plus metronidazole appeared to be theoretically effective in 99.2 per cent (118/119) of our specimens; this finding is supported by other studies. However, the rare but potentially life-threatening complications of quinsy must be recognised.

Different strategies are available for the management of patients with early (i.e. tumour stage one or two) oral or oropharyngeal carcinoma and a clinically negative neck.

In 2006, a questionnaire was sent to the eight head and neck cancer centres of the Dutch Head and Neck Oncology Cooperative Group. This questionnaire covered: the factors influencing the decision to perform an elective neck dissection; the neck staging procedure; and the types of neck dissection undertaken.

All eight questionnaires were returned completed. Respondents indicated that the site (n = 6), size (n = 7) and thickness (n = 6) of the primary tumour were important in decisions regarding elective neck dissection. Ultrasound-guided fine needle aspiration cytology was the most frequently used diagnostic technique (n = 7). Depending on the site and stage of the primary tumour presented, in the different cases 3–7 of the centres would perform an elective neck dissection. Selective neck dissections (i.e. levels I to III/IV) were more frequently performed than modified radical neck dissections.

There was no uniformity regarding management of the clinically negative neck in patients with early stage oral and oropharyngeal carcinoma, within The Netherlands.

The intact posterior meatal skin, canal wall down technique for difficult cochlear implantation provides expanded access to the middle ear for cochleostomy in cases of obscured middle-ear landmarks, limited facial recess access and limited mastoid cavity dimensions. Careful preservation of the posterior canal wall skin in this procedure obviates the need for obliteration of the middle-ear mucosa and closure of the external auditory canal.

To present a canal wall down technique for cochlear implantation, which preserves the intact posterior external auditory canal wall skin. This approach is employed when a standard facial recess cochleostomy is not possible.

Three cases of intact posterior meatal skin, canal wall down cochlear implantation are presented together with long-term follow-up results. In all three cases, implantation via a facial recess approach was not possible. One patient suffered from severe cochlear otosclerosis with obliteration of the round window niche. The second patient had severe middle-ear fibrosis with encasement of all middle-ear structures and obliteration of routine landmarks. The third patient had an anterior sigmoid sinus obscuring access to the facial recess. Cochlear implantation via the canal wall down, intact posterior canal wall skin technique was successfully performed in each of these patients.

All three patients were successfully implanted, with full electrode insertion achieved. All patients subsequently became active implant users. One patient did suffer from a minor wound complication post-operatively, unrelated to the approach. Patient follow up ranged from four to six years.

The aim of this study was to investigate the contribution of electronystagmography and magnetic resonance imaging to the aetiological diagnosis of vertigo and unsteadiness, in a population in which the history and clinical examination provide no conclusive diagnosis of the origin of the dysfunction (i.e. peripheral or central).

This retrospective study included 102 patients, who underwent full ENT clinical evaluation, history and neurotological assessment (including pure tone audiography, auditory brainstem response testing, electronystagmography and magnetic resonance imaging).

Electronystagmography contributed to establishment of a diagnosis in 53/102 patients (52 per cent), whereas magnetic resonance imaging did the same in four of 102 patients (3.9 per cent).

Electronystagmography remains the most useful examination for aetiological diagnosis of patients with vertigo and unsteadiness, since the actual number of patients with vertigo and unsteadiness of central origin is small (3.9 per cent), even in a population in which history and clinical examination may indicate an increased probability of central nervous system dysfunction.

To report the successful use of a surgical approach for the treatment of drooling in a case of oro-motor dyspraxia.

A seven-year-old girl with a diagnosis of oro-motor dyspraxia was referred for management of drooling; this was her only symptom. There were no focal neurological abnormalities. Conservative measures had not helped, and her parents were keen for definitive treatment. Bilateral submandibular duct transposition was performed with no complications. The patient's drooling improved immediately.

There are currently no reports in the literature of surgery for persistent drooling in children with oro-motor dyspraxia who are otherwise neurologically and developmentally normal. The mainstay of treatment is speech and language therapy. We report the successful use of surgical techniques, usually reserved for children with cerebral palsy or severe neurological disorders, to treat drooling in an otherwise normal seven-year-old child with oro-motor dyspraxia.

In recent years, techniques such as computerised dynamic posturography have facilitated objective evaluation of patients with balance disorders. In this study, we used computerised dynamic posturography for clinical staging of Ménière's disease.

We applied a computerised dynamic posturography sensory organisation test to 53 patients with American Academy of Otolaryngology criteria of Ménière's disease. The following parameters were considered in data analysis: computerised dynamic posturography scores for testing the patient's centre of gravity with a mobile surface, immobile visual surroundings and eyes closed, scores for testing with a mobile surface, mobile visual surroundings and eyes open, and vestibular ratio. We used four hearing threshold stages (although we had no patients at stage four).

This study did not observe a statistically significant correlation between audiometric hearing thresholds and computerised dynamic posturography scores. Computerised dynamic posturography scores showed statistically significant variation with time elapsed since the last vertigo attack. Although our results showed an increasing trend in computerised dynamic posturography scores as Ménière's disease activity level decreased from recent post-attack (i.e. less than one week since last attack) through late post-attack (i.e. one week to 60 days since last attack) to inactive (i.e. more than 60 days since last attack), these differences were not statistically significant.