A patient is reported with a peritonsillar abscess yielding Arcanobacterium haemolyticum. This appears to be only the fifth such case described in the medical literature and the first from Europe. The organism has been reported as an occasional cause of tonsillopharyngitis with rash, resembling infection with Streptococcus pyogenes but often unresponsive to penicillin therapy. A. haemolyticum easily passes unrecognized in bacteriological cultures as a result of its slow growth, coryneform appearance in the Gram's stain and weak haemolytic activity on conventional laboratory media.

Leukaemic cell infiltration of the nose as a first manifestation of the disease is extremely rare. We report a case of a three year-old child who had presented with a swelling at the root of the nose for one month and proptosis of the right eye for one week. CT scan revealed a mass infiltrating the nose and nasal cavity along with infiltration of the retro-orbital region. Biopsy showed it to be myeloid cell deposits. Patient was put on antileukaemic chemotherapy but died two months after the first appearance of the symptoms.

Small foreign bodies lodged anteriorly in the tympanic sulcus are usually not visible, due to the curve of the external ear canal. Such objects can be seen with the aid of an otomicroscope and micromirror or with an endoscope, and removed by irrigation. If irrigation fails, epithelial migration on the tympanic membrane may remove lodged foreign bodies, although this may take months. Our new method, which uses water to locate small objects lodged in the tympanic sulcus, includes irrigation of the ear, adjustment of the water level to the middle curve of the external ear canal, and use of the water surface as a concave lens, making the tympanic sulcus visible. With otomicroscopy a curved ear probe can then be used to remove lodged foreign bodies from behind the curve.

An unusual case of pleomorphic adenoma with exuberant bone formation, occurring in the maxillary antrum of a 21-year-old male and showing repeated recurrence, is reported. In contrast to the endochondral ossification in the previous reported cases of pleomorphic adenoma, direct deposition of osteoid by metaplastic myoepithehal cells is suggested to explain the bone formation. The difficulties of distinguishing this tumour from osteosarcoma during intraoperative diagnosis are discussed.

Subglottic and tracheal stenosis frequently present difficulties in management.

Two cases of subglottic stenosis occurring after prolonged endotracheal intubation are presented where the vertical length of complete obstruction by scar tissue was greater than 2.5 cm. One case was successfully managed by the use of the laser and immediate insertion of a stent. The other case still requires subglottic stenting, although an excellent lumen was established by laser vaporization of the stenosed segment.

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.

Darier's disease is a hereditary dermatological condition characterized by crusted papules distributed over the seborrhoeic areas of the trunk and head. A case of Darier's disease presenting to the Otolaryngology department because of severe involvement of the pinna is reported. The typical histological appearances are described and treatment discussed.

Dysphagia is a common symptom presenting to ENT departments. Two cases of tetanus with dysphagia as a major symptom are discussed, together with a review of previously reported cases. Although tetanus is a rare disease in the United Kingdom, the possibility of this diagnosis should be borne in mind in patients presenting with progressive dysphagia, especially if there are other head and neck symptoms present.

A case of metastatic laryngeal paraganglioma is presented. We have reviewed the current world literature on this entity and thereby identified two apparently distinct types of this rare lesion (type I and type II).

The histopathological features are unhelpful in discriminating these two types and this is instead based on clinicoepidemiological differences. The latter are annotated and discussed with respect to prognosis and management. A true estimate of the frequence of type II (potentially malignant) awaits the utilization of the recent improvements in diagnostic. techniques.

Silicone septal buttons have been available to obturate septal perforations since the 1970s. Various methods of insertion have been suggested but the procedure is not always easy. We have devised an alternative method which has proved quick and simple to perform.

We present a case of nasal deformity due to sarcoidosis. The surgical management is discussed. The risk of secondary involvement of implanted autologous cartilage by the disease is emphasized. For this reason an inert allograft (silastic) is recommended for augmentation in this group of patients.

A case of early marked calcification of the arytenoid cartilages is presented in a patient with a suspected pharyngeal foreign body. The calcification on X-ray had the appearance of the expected foreign body. Calcification of the arytenoid cartilages is discussed.

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.

A patient was referred to us with a mass in her upper jaw. This was diagnosed to be a chondrosarcoma of the maxilla. The mass was removed surgically. We present the case here and discuss the salient features.

Four male patients with pseudocyst of the auricle were successfully treated with oral corticosteroids. This condition is an asymptomatic, non-inflammatory, cystic swelling, usually located in the scaphoid or triangular fossa of the anti-helix which if untreated, leads to deformity of the pinna. All successful methods of treatment described in the literature so far have been invasive. All four patients in the above series responded to oral steroid therapy alone.

We present a case of a patient who sustained a bullet wound to the mouth and face resulting in impaction of the foreign body in the neck. This was initially managed conservatively until migration into the supralaryngeal area occurred. This resulted in airway obstruction, dysphagia, and dysphonia necessitating resuscitation and per-operative intrapharyngeal removal.

Bullet wounds are uncommon in this country and experience with these cases is lacking. This paper discusses the various management options and the mechanism of how the bullet became lodged in the tissues of the neck.

The third case of a double pharyngeal pouch is reported. It was excised and the patient made an uneventful recovery.

Ceruminous glands should no longer be regarded as purely apocrine glands, but as apoeccrine glands with both apocrine and eccrine modes of secretion. We present two cases of pleomorphic adenoma of ceruminous glands, among the rarest of such tumours. The use of such terms as ‘ceruminoma’ and ‘hidradenoma’ should finally be abandoned, and ‘ceruminous gland tumour’ used instead as a generic term. Classification should be based on Wetli's prototype (adenoma, pleomorphic adenoma, adenoid cystic carcinoma and adenocarcinoma), with the addition of benign eccrine cylindroma and syringocystadenoma papilliferum; the inclusion of mucoepidermoid carcinoma should await full validation. Wide local excision is necessary for all tumours, with only follow-up for histologically benign neoplasms. Malignant tumours need early aggressive surgery and radiotherapy. If marginal invasion cannot be assessed histologically, then adenoma and adenocarcinoma cannot be distinguished and we suggest that the tumour be reported as ‘of uncertain malignant potential’. Long-term studies are needed to confirm or refute the view that all ceruminous gland tumours are potentially malignant.

Therapeutic radiation for malignant conditions is known to cause sarcomatous change in an irradiated field after a latent period; equally this change may occur following radiotherapy to benign conditions which may result in a more difficult management problem later. Radiotherapy to benign conditions should be reserved for use after failure of conventional surgery or other interventional techniques.

A case report of a cavernous haemangioma arising in the nasal bones is described, together with a discussion of the relevant literature. The condition, although rare, can be reliably diagnosed pre-operatively.