Pre-operative Computerized Tomography was performed prior to second look operations in 10 cases to check for cholesteatoma after combined approach tympanoplasty. Three independent opinions were obtained on the CT scans and compared with the operative findings.

This small series failed to demonstrate reliable pre-operative radiological detection of cholesteatoma. There was disappointing inter-observer agreement in interpretation of the CT scan

A prospective study of 46 consecutive patients with nasal septal haematoma admitted at the General Hospital, Owerri, Nigeria over a five year period is presented. The disease was commoner in males than females. The majority of the cases (65.6 per cent) were of unknown cause and were therefore grouped as spontaneous haematoma while 30.4 per cent were due to trauma. Trauma was more common in patients below the age of 15 years while spontaneous haematoma was common in patients above that age. All the patients with septal haematoma represented 0.2 per cent of total attendances to the ENT clinic over the period. Most of the patients presented with severe and threatening symptoms necessitating intense aggressive management. All the patients were managed by surgical incision and drainage, four had marked nasal abnormalities. Three patients died from a brain abscess as a complication of infected haematoma.

A personal series of 842 patients with a tumour of the oral cavity is presented. Five hundred and twelve of these patients had a histologically proven squamous cell carcinoma, and were previously untreated.

Increasing age was associated with worsening performance status. Women were older at presentation than men, and tumours of the upper part of the mouth were more common in the elderly, but there was no relation between age and histological grade or stage grouping.

Sex had no correlation with performance status or histological grade. However, men were more likely to have an advanced tumour, and tumours of the floor of the mouth and alveolus were much commoner in men.

There was no correlation between performance status and site or histological grade, but patients in poor general condition were more likely to have stage III-IV tumours.

Multivariate analysis showed that sex had no impact whatever on survival, but survival fell with increasing age and worsening performance status. The effect of age and performance status disappeared when the survival of treated patients was adjusted for deaths due to other causes.

A four-year study was undertaken to determine the value of electron microscopy in the diagnosis of head and neck tumours. During this period 80 samples were submitted for examination, of which 69 contained assessable tumour. Electron microscopy made a major contribution to the diagnosis in 25 cases (36 per cent). Areas in which ultrastructural examination was of diagnostic significance included the precise categorization of apparently undifferentiated carcinoma and the identification of melanomas. Little diagnostic benefit was gained from electron microscopic examination of thyroid, lymphoid or salivary gland neoplasms. The value of electron microscopy in relation to immunohistochemistry is discussed.

A prospective study in 53 eligible patients, undergoing major head and neck cancer surgery was carried out to assess the combination of an ureido penicillin, piperacillin with a nitro imidazole agent, ornidazole, in order to prevent post-operative general and wound infections. Both antibiotics were administered for five days. Each patient had piperacillin 4 gm every eight hours and ornidazole 1 gm every 24 hours.

The overall rate of infections was 13.2 per cent (n = 7), with 3.8 per cent (n = 2) wound infections and 11.3 per cent (n = 6) general infections (one patient presented both complications).

There was no wound infection in the total surgery group (n = 12). General infections who only consisted of pneumonias were respectively 12.2 per cent (n - 5) in the group with partial procedures (n = 41) and 8.3 per cent (n = 1) in the total surgery group.

This antibioprophylaxis can be recommended in major oncological neck surgery, specially in the case of partial procedures.

The results of single modality treatment using surgery or radiotherapy alone in advanced head and neck cancers are known to be unsatisfactory. The present study analyses 252 cases with stage III and IV resectable cancers of the head and neck region selected to be treated by a combined regime of pre- or post-operative radiation and radical surgery. Only 193 patients completed the treatment protocol. There were 58 cases (33.5 per cent) who failed either at primary or regional sites or both. Nine cases (five per cent) developed distant metastasis. Absolute and determinate four year disease-free survival was 55 per cent and 61 per cent respectively. Early lesions (stage I and II) have been excluded from the study. The study indicates that a reduction in primary and regional failures correlates well with a combined therapy, though prolonged treatment may affect patients' compliance to some extent.

The surgical approach to the hypopharynx by lateral pharyngotomy as described by Trotter has found widespread use in management of supraglottic carcinoma. A similar but more conservative approach may be employed for removal of cysts and benign or well-encapsulated neoplasms of the epiglottis and supraglottic space. We call this approach a supero-lateral thyrotomy, to differentiate it from the classic lateral pharyngotomy.

Surgery consists of subperichondrial resection of the superior half of the ipsilateral thyroid cartilage with preservation of internal lining and superior laryngeal nerve. The lesion may then be enucleated or resected, and the defect, if any exists, closed with overlying mucosa and the flap of preserved perichondrium. The technique has been employed in cases of paraganglioma, haemangiopericytoma and saccular cysts.

We prospectively studied 190 patients undergoing tonsillectomy or nasal surgery to assess the value of two structured interview techniques. There were four groups: Group A did not have a consent interview during the study period. Group B had an informal interview. Group C had a structured interview and Group D had a structured interview and were given an information sheet. Anxiety assessments were made and patients' recall of the operation name, details of the operation and its complications was assessed.

Patients had higher than normal anxiety levels when admitted, but several hours after the interview anxiety was normal for Groups B, C and D. Group A maintained a higher anxiety level.

Only 37 per cent correctly recalled the operation name, where as 87 per cent of all groups recalled the explanation of the operation. However, Groups C and D recalled a higher mean number of complications per patient.

A structured interview when obtaining informed consent increases the number of complications recalled without increasing pre-operative anxiety.

Myringotomy is one of the commonest procedures carried out by ENT surgeons. Analysis of middle ear aspirate is sometimes helpful in the management of ear disease. A simple method of constructing an apparatus for collection of middle ear aspirate is described.

Topical anaesthesia using EMLA cream is an established anaesthetic technique for ventilation tube insertion in adults. We report its use in 103 children (age range 3–12 years). Failure occurred in seven patients (6.8 per cent); complications occurred in two patients and were of a minor nature. This technique appears well tolerated provided the operator avoids the use of suction and allows a cream penetration time of greater than two hours. The use of a ‘T’ myringotomy is also recommended, to reduce tension on the drum at tube insertion.

Cerebellar haemangioblastomata and angiomata of the retina are the most common vascular tumours seen in von Hippel-Lindau disease. A definite association between this condition and choroid plexus tumour has not been described previously and its presentation as a middle ear mass is unique.

A 53-year-old male patient had been suffering from severe aural symptoms (pulsatile right-sided tinnitus and paroxysmal dizziness attacks with nausea) and right hemifacial spasm. Treatment had involved stellate ganglion block with lignocaine and the injection of intravenous sodium bicarbonate solution for attacks of Meniere's syndrome and facial nerve block with lidocaine for hemi-facial spasm. Despite these treatments, the dizzy attacks became more frequent, developing into the clustering state. Air CT cisternography and vertebral angiography demonstrated an enlarged and curved vertebral artery. Vascular cross-compression of the Vllth and VHIth cranial nerves was therefore suspected. Microvascular decompression was performed. After operation, the pulsatile tinnitus, dizziness and hemifacial spasm disappeared. From the present case and a review of the literature, we conclude that vascular cross-compression of the VHIth cranial nerve should be an indication for microvascular decompression only when symptoms of vascular cross-compression of the Vllth cranial nerve are also seen.

Rhinosporidiosis is an inflammatory disease of the nasal mucosa caused by Rhinosporidium seeberi. The disease is endemic in India but very rare in Europe or other continents. The literature concerning aetiology, clinical appearance, morphology and treatment is reviewed. All reported European cases are summarized.

We report an unusual case of cardio-respiratory arrest and eventual death secondary to a benign tumour of the oral cavity obstructing the oropharynx. We review the literature of similar occurrences causing difficulty with respiration and intubation, and highlight the importance of early diagnosis and treatment.

We describe a case of a giant sialolith of Stensen's duct in a 48-year-old woman. The patient was investigated and treated with a mistaken diagnosis of chronic inflammation until the clue to the diagnosis was provided by plain radiography. This is an unusual presentation of a salivary calculus and to our knowledge such a huge parotid calculus has not been reported so far in the literature.

The case of a vallecular cyst in a neonate is described. The presentation was with failure to thrive. This previously unreported mode of presentation is discussed, and aspects of the management are emphasized. In particular, the value of flexible nasopharyngoscopy in assessing the neonatal laryngopharynx is highlighted.

Laryngeal chondrosarcoma is an uncommon tumour, approximately 200 cases having been reported in the world literature. We report a case which was noted by chance in a patient undergoing general anaesthesia for an unrelated procedure.

Tuberculosis is a disease of protean manifestations, and despite a falling incidence is still prevalent in our society.

We present a case of a child whose history and preoperative chest radiograph suggested the presence of a foreign body, but subsequent examination of the material removed at endoscopy revealed a diagnosis of tuberculosis. We suggest that all friable material removed from the lower respiratory tract be submitted for microscopy, culture and histopathology with this diagnosis in mind.

Although advances in antibiotic therapy have made adult neck space infections an uncommon event, it is essential to bear them in mind when treating oro-dental and oro-pharyngeal sepsis, as they can often progress with life threatening sequelae.

Three cases of neck space infection as a consequence of dental infection, pharyngitis and peritonsillar abscess are presented. The management of a potentially compromised airway is of paramount importance in the immediate treatment of neck space sepsis.

The purpose of this paper is to focus attention on this rare disorder. Two cases are reported: one involving the neck and the other the nose and paransal sinuses. The treatment of choice is wide surgical excision wherever possible.