A study was conducted to ascertain whether there is any relationship between parental smoking and various factors in children undergoing surgery for otitis media with effusion.

Information was recorded on 115 children admitted to hospital for grommet insertion. Details of parental smoking habits, previous surgery for ottis media with effusion and operative findings were noted. A group of 36 children with healthy ears attending an orthoptic clinic were used as controls.

Those children with at least one parental smoker were found to have a higher chance of being admitted to hospital for grommet insertion and were more likely to have had previous surgery for otitis media with effusion.

The round window reflex is normally absent in stapedial fixation. In this study, six cases of oval window fistula are described in which the round window reflex was absent. This is probably because there is insufficient pressure transmitted to the round window membrane through the perilymph because of leakage from the oval window. This is considered as an important diagnostic sign of oval window/stapes footplate ligament disruption.

Conjunctival innoculation is a previously unrecognized hazard for the otologist during mastoid surgery. This experiment assesses the spread of droplet contamination during temporal bone dissection. The results suggest that otologists and assistants should wear eye protection during exposure of the mastoid antrum by drilling.

Neurological surgery of the paralysed face can be rewarding if performed early using appropriate surgical techniques. The results of 32 operations are analyzed. Excellent restoration of facial function is achieved with early surgical intervention but some results are poor. The reasons for failure are analyzed.

Nasal implants of autologous costal cartilage have an undesirable tendency to distortion. This tendency may be reduced by the process of devitalization, which occurs in the preparation of homologous costal cartilage for storage in a tissue bank. An in vitro study has been undertaken, utilizing five common methods of cartilage preparation (cialit, ethyl alcohol, formalin, glutaraldehyde and irradiation) to determine whether there is any significant variation in the degree of distortion which occurred and any variation in cartilage consistency. We conclude that all of the methods evaluated would produce banked homologous costal cartilage with an equally low incidence of distortion but implants are less readily carved from cartilage stored in cialit.

The effectiveness and safety of surgical reduction of the inferior turbinate was assessed in 22 children of 15 years and below. All were interviewed and assessed by means of a questionnaire seven to 51 months post-operatively. Sixty-eight per cent of the children reported a sustained improvement in their nasal airway. There were no significant post-operative complications in this series. In particular there were no cases of serious post-operative haemorrhage, excessive dryness or crusting of the nose. It is concluded that surgical reduction of the inferior turbinate is a safe and effective option in the treatment of children with severe nasal obstruction.

Simple fracture of the nasal bone can be reduced under local or general anaesthesia. A combination of topical anaesthetic (EMLA cream) and cocainization of the nasal mucosa was used successfully in manipulation of fractured nasal bones in twelve patients without discomfort.

A prospective study on 210 patients was conducted to determine the relative efficacy of infiltration anaesthesia as against surface anaesthesia for antral lavage. The patients were categorized into three groups and comparisons were made on patient response and our observations. This study confirms that infiltration technique is superior to surface anaesthesia and is, also, less time consuming.

The rigid Hopkins endoscope has been applied to simplify the operation of dacryocystorhinostomy, preventing unnecessary trauma to the medial orbital tissues. The success of the surgical technique is absolutely dependent on a thorough knowledge of the relevant surgical anatomy.

One hundred children and twenty adults were randomly allocated to guillotine or dissection tonsillectomy operations. The study was prospective and double-blind. In the children, the guillotine technique had demonstrable advantages over the dissection technique in terms of duration of operation, blood loss and post-operative pain. There was no significant morbidity in either group. In the adults, the random allocation of patients into these groups was found to be technically unsatisfactory and this arm of the study was abandoned after twenty patients.

A double blind controlled prospective trial investigated the analgesic effect of topical Bupivacaine in 15 adult patients undergoing bilateral tonsillectomy. Each patient had one tonsillar fossa exposed to Bupivacaine 0.5 per cent solution and the other to normal saline. When visited four to six hours post-operatively, 12 out of 15 patients (80 per cent) stated that the Bupivacaine exposed side to be more uncomfortable than the saline exposed side. On the first post-operative mornning 9 out of 15 patients (60 per cent) confirmed the same. The remaining patients were unable to detect a significant difference and no patient found the Bupivacaine side to be more comfortable.

These results suggest that topical Bupivacaine 0.5 per cent solution has no place in providing post-operative analgesia in adult tonsillectomy.

Suppression of salivary flow is of value in the management of salivary fistulae and sialectasia. It may also be beneficial in mentally defective patients and those with neurological palsies lacking control of their salivation. Nine patients were treated by irradiation to the parotid gland to control salivary flow; eight had complete resolution of symptoms and one had partial relief. Irradiation was effective as primary treatment and after failed surgery and/or drug treatment. Low doses were effective and there were no significant acute or long-term side effects. Its use avoids long-term medication and their potential side effects and may reduce the need for surgery.

Schistosoma mansoni is common in Nigeria as well as in other countries of West Africa (Edington, 1979). The eggs are laid in the small venules of the submucosal layer of the intestinal wall and pass out usually in the faeces but some may enter the blood stream to be found in any organ of the body (Edington et al., 1975). However, a careful search of the available literature failed to reveal any report of schistosomiasis in the ear and hence it was decided to publish this rare case.

An 80-year-old man was seen in the clinic with a two month history of pain, bleeding and deafness in his left ear; accompanied by a left facial palsy. Six months earlier, anaplastic carcinoma of the bladder had been diagnosed and treated with radiotherapy. On examination there was a mass in his left external auditory canal and VII, VIII, IX and X left cranial nerve palsies. Histology of a biopsy was identical with his original bladder tumour. He received a course of palliative radiotherapy but died shortly after. Post-mortem demonstrated the left temporal bone metastasis extending into the middle and posterior cranial fossae. There was no evidence of residual bladder tumour, or other primary tumour. Temporal bone metastases are probably more common than generally thought. Presentations like this may become more common as cancer therapy improves, with patients surviving longer and presenting later with metastatic disease.

Metastatic tumours of the paranasal sinuses from primary lesions of the urogenital tract are rare, with about 50 cases so far being reported in the literature. The most frequent primary lesions is a renal carcinoma. We have experienced a case of paransal sinus malignancy. There were no symptoms of urinary tract carcinoma preceding those in the paranasal sinuses. This case was later revealed at autopsy to be a metastasis from a diverticulum of the urinary bladder.

We report two cases of massive invasive pituitary adenoma with the unusual presentation of nasal obstruction. In both cases the diagnosis was only made when the obstructing tissue was removed. Cases reported previously have usually presented with severe focal neurological signs or a long history of neurological symptoms. These two cases are unusual in having minimal neurological deficits despite the extension of tumour into the nasopharynx and the middle and posterior cranial fossae. These extensions were well illustrated by computerised tomography. This unusual presentation is discussed with reference to the literature.

A 67-year-old man with a progressive snoring habit is presented. Fluctuant bilateral abductor vocal cord paralysis was later recognized together with autonomic features suggesting a diagnosis of Shy-Drager syndrome. Snoring as a presenting feature of this condition has been infrequently described. This case highlights the importance of careful assessment of snorers.

Dermoids, or hairy polyps, are rare lesions affecting the head and neck region. To date approximately 120 cases have been recorded. They arise during early embryogenesis and are invariably benign. Unlike the more differentiated types of teratoma, hairy polyps are derived from only two germinal layers, ectoderm and mesoderm. Most originate in the oro-nasopharyngeal region, either as pedunculated or sessile masses. They usually present at, or soon after, birth with signs of upper aerodigestive tract obstruction. Treatment consists of surgical removal. In young children with airway compromise, the expertise of an experienced paediatric anaesthetist is essential.

Three new cases of hairy polyp are described to add to the present literature. Two originated in the nasopharynx and one in the oropharynx. Interestingly, one patient, a neonate, also suffered from severe osteopetrosis. All lesions were removed by simple surgical excision under general anaesthesia. There were no operative or post-operative complications.

Warthin's tumour arising from minor salivary glands of the nasopharynx is described in a patient with eosinophilic rhinitis and nasal polyposis. The microscopical features of this lesion were indistinguishable from those of Warthin's tumours of the parotid gland. The present case supports the histogenetic theory that the epithelial component of extraparotid Warthin's tumours represents reactive oncocytic metaplasia and hyperplasia induced by chronic inflammation rather than genuine neoplasia. It is suggested that the term Warthin's tumour is preferable to designations indicating neoplasia of these extraparotid lesions which are indistinguishable histologically and ultrastructurally from parotid and juxtaparotid adenolymphomas.

A case of a glial teratoma occurring in the tongue of a twelve week old male child is presented. This lesion was thought clinically to be a lingual thyroid. Histopathological examination revealed the true nature of the lesion. The mother had noticed the lesion since birth but only sought medical attention when the child developed difficulty in breathing.

Teratomas in the head and neck region are uncommon and are commonly diagnosed wrongly as lingual thyroid. These lesions are usually benign.