The field of audiological rehabilitation in adults faces an array of opportunities. Some of these are technological, as with the advent of fully digital hearing-aids, and some involve clinical practice, such as opportunities for true multidisciplinary working, and for changes in hearing-aid prescription and provision. The development of well-validated questionnaire instruments should facilitate robust research into the effectiveness of clinical interventions in adult audiological rehabilitation, for such evidence is urgently needed if the field is to thrive.

Asian nations differ from one another in population, cultural background, ethnic tradition and economic situation. The training of otorhinolaryngologistsin Asia is not in any way uniform. A questionnaire survey of 26 leading institutions in 12 countries/regions was carried out. The emphasis of investigation is towards the training programme for specialists in Otorhinolaryngology and continuous medical education (CME). The response rate of the survey was 100 per cent. The duration of training for otorhinolaryngologists ranges from three to seven years and an exit assessment is held in seven countries/regions. The training programmes are modifications of either the British or the American pattern depending on tradition. Documentation of CME is available in eight countries/regions while a defined cycle has been established in only three. Medical/health authorities or professional societies in each country contribute towards its monitoring. Better communication and sharing of experience will improve the training of otorhinolaryngologists in Asia.

The technique of onlay sandwich grafting of tympanic membrane perforations fashioned by the use of pedicle flap raised from the posterior deep meatal skin and autologous temporalis fascia is described. The results of a series of 124 ears operated between 1987 and 1999 are the basis of this report. Of these 106 patients had myringoplasty for the first time. The operation was successful in 102 (96.23 per cent) patients. Eighteen patients had revision myringoplasty, with a successful result in 14 (77.78 per cent). None of the patients developed complications usually associated with onlay grafting. A preliminary report of this work was presented at the XVI World Congress of Otolaryngology Head and Neck Surgery at Sydney in 1997.

Two hundred and sixty patients tested with electronystagmography (ENG) for evaluation of complaints of disequilibrium were the representative sample for this study. As all new dizzy patients currently receive an ENG, the goal of this project was to determine how much an ENG adds to the diagnostic acumen, and which patients really needed an ENG in order to maximize efficiency and minimize patient cost. Results indicate the suspected diagnosis prior to ENG is assisted by its use only when the cause is thought to be central or is uncertain. The percentage of unknown causes of disequilibrium decreased from 34.2 to 13.8 per cent and the percentage of central causes increased from 13.1 to 23.1 per cent. Electronystagmography does not significantly aid in the diagnosis of peripheral lesions except as confirmation. Specific findings and recommendations are discussed.

Middle meatal samples were obtained from 52 carefully selected healthy adults. In 75 per cent of the test subjects bacterial organisms were cultured. However, growth was often poor and the predominant species suggest a commensal flora: coagulase-negative staphylococci were retrieved from 35 per cent, Corynebacterium sp. from 23 per cent and Staphyloccus aureus from eight per cent of the adults. These data are very different from those previously obtained among children where – even in the absence of obvious ENT pathology – the most frequently cultured organisms were typical sinusitis pathogens: Haemophilus influenzae present in 40 per cent, Moraxella catarrhalis in 34 per cent and Streptococcus pneumoniae in 50 per cent of children. Furthermore, Streptococcus viridans and Neisseria sp., both organisms that might be able to inhibit colonization by some of the pathogens and found commonly among children, are virtually absent in healthy adults.

An operation is described for correction of unilateral cleft lip nasal deformity which has had considerable uniformity of success and is applicable to both mild and severe degrees of deformity. Our proposed repair technique is performed through an external rhinoplasty approach and depends on repositioning of the displaced and deformed cartilages together with the reinforcement of the structural support of the nose by using multiple cartilage grafts. This surgical technique was used in 18 consecutive adult patients with unilateral cleft lip nasal deformity and yielded consistently good long-term functional and cosmetic results.

Surgery offers the optimum modality of treatment for inverted papilloma although a considerable range of operative approaches have been described. The results are presented in a cohort of 37 cases treated by both endoscopic and combined endoscopic and external approaches with a recurrence rate of eight and 21 per cent respectively. This series is compared with those in the literature and demonstrates that it is extent of disease which primarily determines the choice of surgical approach, with previous treatment, individual patient factors and surgical expertise as secondary determinants.

Abnormalities of p53 tumour suppressor gene are detected in a diversity of malignancies and play an important role in their pathogenesis. Hypopharyngeal carcinoma is the most morbid among head and neck squamous cell carcinomas because of the high incidence of treatment failures and because a biological marker predictive of the treatment failures remains elusive. The expression of p53 protein in 46 hypopharyngeal squamous cell carcinomas was examined histochemically and p53 immunoreactivity was found in 19 of 46 cases (41.3 per cent). The rate of second primary tumour development was significantly higher in the p53-positive group than in the p53-negative group (p = 0.039), whereas that of tumour recurrence was not significantly different between the two. Moreover, there was no statistically significant difference in either overall or disease-free survival between the p53-positive and -negative groups. These results indicate that although p53 expression significantly correlates with second primary tumour development in patients with hypopharyngeal squamous cell carcinomas, it is not predictive of the clinical outcome.

Flexible fibre-optic nasendoscopes have become a ubiquitous ENT out-patient tool for the inspection of the nasopharynx, larynx and hypopharynx. Disinfection of the instrument between patient use is important to prevent potential spread of infection but the methods used vary considerably. We designed a questionnaire which was piloted and then sent to 115 UK ENT out-patient departments to establish current UK practice. Most units (67 per cent) use a chemical soak system but the type of chemical disinfectant, the method of delivery and the duration of soak varied considerably. A few hospitals use a disposable plastic sheath system and others simply wipe the instrument with an alcohol swab in between patient use. The protocols for disinfection after high risk patients e.g. human immunodeficiency virus (HIV), hepatitis B varied from hospital to hospital.

The results demonstrate a lack of standard practice that is wasteful of financial resources and may expose patients to unnecessary risk. There is a need for an authoritative ENT body to publish national guidelines as may be found in other specialities and other countries.

A concha bullosa may require surgical reduction to facilitate access to the middle meatus during endoscopic sinus surgery. Here we describe an original instrument which enables this procedure to be performed simply with minimal mucosal damage.

Tinnitus produced by repetitive contraction of the middle-ear muscles is a rare condition. We present an interesting case of bilateral middle-ear myoclonus causing incapacitating tinnitus in a patient with multiple sclerosis. Otological examination demonstrated rhythmic involuntary movement of the tympanic membrane. These movements correlated with a rhythmic ‘rushing wind’ noise perceived by the patient. Oropharyngeal examination showed no evidence of palatal myoclonus. Impedance audiometry confirmed rhythmic change in the middle-ear volume. Medical management was unsuccessful. The patient’s tinnitus was subsequently cured with bilateral sectioning of the tensor tympani and stapedial tendons.

Disorders of the first branchial cleft are rare and often present difficulties in diagnosis. A case is reported that presented with the clinical and histological features of cholesteatoma. The embryology, diagnosis and treatment of branchial arch defects are also reviewed. The case highlights the fact that a high index of suspicion should be aroused for patients with a discharging ear in the presence of an intact tympanic membrane.

Although a few cases of facial palsy following mandibular nerve block and dental surgery have been described, it would appear that herpes zoster oticus following dental surgery has not been documented. It is possible that the latent virus may be activated by the mandibular nerve block and dental surgical interventions. Two cases of herpes zoster oticus, both following inferior alveolar nerve block anaesthesia for dental treatment are presented.

Osteosarcomatosis (also known as multifocal osteosarcoma or multiple sclerotic osteosarcoma) is a rare condition, characterized by multiple skeletal lesions at initial presentation. We describe a case of osteosarcomatosis involving craniofacial bones presenting with cranial nerve palsies. In addition, a brief review of the literature is given, with a discussion of this highly aggressive form of osteosarcoma.

Several lipomas of the nasal cavity and paranasal sinus have previously been reported to date. We present a 21-year-old case with nasal lipoma situated on the left posterior of part of the nasal septum, operated on endoscopically. The present case is, to our knowledge, the first report on nasal lipoma in the adult.

We report a rare case of type 1 Chiari malformation which presented to the Otolaryngology department with abductor vocal fold palsy following an aspiration pneumonia secondary to absent laryngeal sensation. Chiari malformations and related cases are discussed.

Congenital vallecular cysts are rare. In this report, four infants having vallecular cysts encountered over a six-year period from 1992 to 1997 were reviewed. All of them presented with upper aerodigestive tract symptoms. Marsupialization was performed in three of them and CO2 laser excision was performed in the fourth patient. There was no recurrence of the cyst in any patient. One of them also had co-existing laryngomalacia. The degree of airway collapse caused by laryngomalacia improved after cyst removal. The laryngomalacia resolved spontaneously. Cyst fluid culture was performed in one of the patients and yielded Staphylococcus aureus but there was no other definite indicator of infection. Staphylococcus aureus could also be isolated in the respiratory tract from two of the other patients.

An 18-month-old boy presented to the accident and emergency department following trauma to the oropharynx by a doll’s umbrella. Although no significant injury could be identified at first, it later transpired that he had developed retropharyngeal surgical emphysema with abscess. This case report aims to review the nature of retropharyngeal abscesses and to highlight and re-emphasize the fact that apparently non-serious pharyngeal injuries in children should be treated with suspicion.

We report a case of metastatic endometrial carcinoma of the neck. A patient with a past medical history of squamous cell carcinoma of the larynx, breast carcinoma and endometrial carcinoma presented with a neck mass. Fine needle aspiration cytology (FNAC) showed this to be a poorly differentiated carcinoma with squamoid features and thus a potentially curative neck dissection was performed. Histology of the mass showed a clear cell endometrial carcinoma. Metastatic gynacecological malignancies to the head and neck are rare and this is the first reported case of metastatic endometrial carcinoma in the neck.