There are four principal modalities now used by the Radiologist to investigate the nose and paranasal sinuses. These are: plain X-ray, conventional tomography, computerised tomography (CT), and magnetic resonance (MR). Plain X-ray is the initial examination, and is used as a screening procedure before employing one of the tomographic techniques. Conventional pluridirectional tomography has now been superseded by CT scannning, which has the advantage of providing both good bone detail and soft tissue imaging. Since the introduction of magnetic resonance (MR), this technique has replaced CT as the optimum method of showing the extent of soft tissue tumour in the sinuses. The introduction of the paramagnetic contrast agent Gadolinium (Gd DTPA) has improved its accuracy. In the anterior fossa discrimination between cerebral oedema and tumour invasion is better shown, and in the sinuses tumour is more easily identified from retained secretion and inflamed mucosa. The best method currently available to show pathology in the nose and sinuses is a combination of GdMR and CT: the former to identify the soft tissues and the latter to show bone changes.

The normal growth pattern of the middle ear cleft was studied on macro- and histological sections of the human fetus.

When compared with adult temporal bones, the inclination of the tympanic ring remains unaltered throughout fetal development.

Expansion of the middle ear cleft is caused by intrinsic growth and by lateral displacement of its constituent elements: tympanic ring, otic capsule and squamous bone. Not only are the two mutually different modes of growth movement quite dissimilar in magnitude and direction, but so is their resultant vector for each constituent; this dissimilarity in growth movement leads to a characteristic change in shape of the middle ear cleft and to the curvature of the tympanic membrane. The intrinsic growth of these elements is simultaneously accompanied by remodelling of their shape; lateral displacement of the squamous bone and tympanic ring is caused by the pressure of the enlarging brain. The consequences of developmental disturbances on the normal growth pattern are discussed.

The effect of amiloride on the murine endolymphatic sac was investigated. The amiloride caused collapse of the lateral intercellular spaces in the endolymphatic sac epithelium and a subsequent mild endolymphatic hydrops. These changes indicated a decreased absorption of endolymph in the endolymphatic sac. Amiloride is known to inhibit the transcellular fluid transport without inducing any changes in the paracellular fluid transport. It is therefore suggested that amiloride specially inhibits the fluid and ion exchange in the apical portion of the epithelial cells resulting a decrease in transcellular fluid transport across the endolymphatic sac epithelium. The transcellular fluid transport seems to be one of the main mechanisms in the endolymphatic sac fluid exchange system.

The authors now report on the histological appearance of two very long-term ossicles, an autologous incus removed from the middle ear at revision surgery 21 years after repositioning and a homologous incus removed from the middle ear after 20 years. Having been placed in formalin immediately after removal from the ear, both specimens were later decalcified by ethylene diamine tetra-acetic acid, embedded in parrafin wax, serially sectioned and stained with haematoxylin and eosin.

Recurrent meningitis in children is not only a potentially life threatening condition, but often involves the child in the trauma of repeated hospital admissions and multiple and invasive investigations to try and find an underlying cause. Symptoms and signs of CSF rhinorrhoea or otorrhoea are infrequent in these patients. Unilateral deafness may be difficult to diagnose in the young child. Full ENT examination may be normal.

We report seven cases of children with recurrent meningitis in whom inner ear abnormalities were only indicated as the site of entry of infection by hypocycloidal tomography or high resolution CT scanning of the temporal bone. Subsequent tympanotomy confirmed the site of the CSF leak as the oval window in the majority of cases; packing the vestibule with muscle halted further attacks in these patients.

Cryosurgery of the labyrinth, as a treatment of endolymphatic hydrops, was initially greeted with considerable enthusiasm, but has latterly received little publicity. That it still has a valuable role is demonstrated by this study of 69 patients who underwent labyrinthine cryosurgery over a 16 year period. Complete relief from vertigo has been achieved in 71 per cent of cases and morbidity has been minimized by the precautions outlined. The literature is reviewed to demonstrate the superiority of the transmastoid approach, the evolution of the technique and experimental evidence for the supposed mode of action.

A study was undertaken to detect undiagnosed deafness in elderly people, living in Part III Residential Homes in North Tees, South Tees and Hartlepool Health Districts, to provide hearing aids and to estimate the subsequent success in rehabilitation. The residents were referred by the senior staff in the homes and assessed by a doctor and audiology technician in a domiciliary setting. Those found to have a significant hearing impairment were prescribed hearing aids without formal pure tone audiometry. A pilot study compared the method of hearing evaluation employed with such conventional testing.

Six months after fitting, the degree of compliance with aiding was assessed. The results show a significant level of undiagnosed deafness in the community and, with this method of provision, an acceptance rate of 41.2 per cent of those recommended for aiding at six months which is higher than suggested by previous similar studies of this population.

Nasal myiasis is a manifestation of the nasal cavities by larvae of the fly of genus Chrysomia. It is prevalent in tropical countries. Atrophic rhinitis is the most commonest predisposing factor for this condition. The maggots can cause extensive erosion of the nose, face and intra-cranial structures occasionally causing meningitis and death. Conservative management by packing the nose with a chloroform and turpentine (1:4) mixture followed by manual removal of the dead maggots is an effective method. Recurrence is known but partial closure of both nostrils to improve the condition of nasal mucosa is the important part of management.

The treatment of chronic maxillary sinusitis aims at the re-establishment of proper aeration and drainage of the antrum. Middle meatal antrostomy offers ventilation and clearance of the antrum and has anatomical, physiological, physical and pathological basis.

This work included 66 cases of chronic maxillary sinusitis, for whom 94 operations of endoscopic middle meatal antrostomy were performed (38 unilateral and 28 bilateral procedures). Any associated anatomical variations and/or pathological abnormalities at the ostiomeatal area were dealt with. Follow-up of these cases for periods ranging from four to 12 months showed that 95.5 per cent of the cases experienced subjective improvement. Endoscopically 96.8 per cent of the antrostomies were patent and 94.7 per cent of the maxillary sinuses were clear and regained healthy mucosa. The author concluded that middle meatal antrostomy, when done endoscopically, is a safe procedure with good results

The technique of antroscopy affords an accurate assessment of chronic sinus disease. It was performed in twelve patients suffering from lepromatous leprosy in order to determine the type, nature and site of the lesion. Antral involvement with lepromatous leprosy may begin with a localized area of erythema progressing to granuloma formation or ulceration. The antero-inferior part of the antrum is the most commonly affected site.

This is a modified subtotal laryngectomy. On the tumour-free side of the larynx, some posterior structures, with their neurovascular supply are preserved. The endolaryngeal mucosa is tubed in continuity with the trachea below and projects into the pharynx above. Thus a myomucosal shunt is formed. Air is directed into it by finger occlusion of the tracheal stoma.

The voice production is highly satisfactory. Aspiration is prevented by constriction of the thyroarytenoid muscle which provides a valved upper end of the tube.

The possibility of leaving tumour in the laryngeal remnant is eliminated by careful selection of patients, and re-confirmation of tumour extent intra-operatively and a frozen section.

Eleven such operations have been performed since October 1983 for squamous cell carcinoma, some previously irradiated. None of the patients had local recurrence. Only one had an aspiration problem which later resolved. All acquired a satisfactory voice

An unusual presentation of a neurilemmoma in the cerebellopontine (CP) angle is reported. The tumour was localised in the CP angle and the case presented with post-auricular swelling and erosion of the squamous part of temporal bone without involvement of the auditory or other cranial nerves.

Previous reports describe Cogan's syndrome occurring in young adults this case shows that it can be diagnosed in an older patient, and that prompt treatment is often successful, making it a worthwhile diagnosis to consider in patients with sudden hearing loss. The erythrocyte sedimentation rate was a useful marker for disease activity in this patient.

Wegener's granulomatosis may present with deafness or other aural symptoms. This report describes two patients with histological evidence of Wegener's granulomatosis who developed reversible sensorineural hearing loss during the course of their illness. The first patient showed complete recovery of a sensorineural hearing loss averaging 50 dB after ten months treatment with cyclophosphamide and high-dose prednisolone. The second patient, who was on maintenance haemodialysis, achieved a 40 dB improvement in sensorineural hearing loss within two weeks of adding cyclophosphamide to pre-existing corticosteroid therapy. These findings suggest that the prognosis of sensorineural hearing loss in Wegener's granulomatosis can be improved with suppression of the vasculitic process by early treatment with combined cytotoxic-immunosuppressive therapy

A definite diagnosis of neuroendocrine carcinoma of the skin is seldom made on initial histological examination; the tumour is usually reported as a poorly differentiated or anaplastic carcinoma. By applying electron microscopy and immunohistochemistry, a correct diagnosis can be made. The ultrastructural examination shows dense-core membrane-bound granules, intermediate perinuclear filaments and desmosome-like junctions. Immunohistochemistry reveals positive staining for neuron-specific enolase and keratin, the latter in a characteristic paranuclear distribution. Confronted with an unusual clinical picture or indefinite histological diagnosis, tissue specimens should be secured for the above mentioned ancillary procedures.

The anti-neutrophil cytoplasmic antibody (A.N.C.A.) test is a solid phase radioimmunoassay which detects autoantibodies specific for Wegener's granulomatosis. The case of a young male is reported with a nasal septal perforation who was extensively investigated revealing no other clinical features, apart from a positive A.N.C.A. test, warranting a diagnosis of Wegener's granulomatosis. It is felt the case represents a false positive A.N.C.A. test and emphasises that the test, whilst useful, should be interpreted in the context of other diagnostic criteria.

A case of primary isolated sphenoiditis that developed cavernous sinus thrombosis is presented. It is difficult to diagnose and patients are often not seen initially by an ENT surgeon, making it more important for other branches of medicine to be aware of this condition. We discuss isolated sphenoiditis with particular reference to the diagnosis, management and complications of this condition

Malignant melanoma of the larynx is a rare tumour. Only 31 cases of primary laryngeal melanoma have been reported in the literature. Cady et al., (1968) found only four cases in a group of 2,500 cases of laryngeal cancer seen over a 25-year period.

A case of primary malignant melanoma of the larynx is presented along with a review of the literature. Problems associated with histological diagnosis are discussed. This patient was regarded as a poor risk for laryngectomy and appears to have control of local disease following application of Carbon dioxide laser.