Cavernous angiomas of the internal auditory canal are rare lesions. The authors present a case of a 29-year-old lady with multiple infratentorial cavernous angiomas, whose sister had previously undergone surgery for a similar supratentorial lesion. She initially presented with an acute brainstem haematoma, secondary to a pontine cavernous angioma. Three years later she developed progressive right-sided sensorineural hearing loss and facial nerve paresis due to an internal auditory canal lesion. This was removed via the translabyrinthine approach and was found to be a cavernous angioma.

This report underlines the multiple and dynamic nature of familial cavernous angiomas, as well as the importance of follow up to determine whether new symptoms are due to the enlargement of known angiomas or the development of new ones. As far as the authors are aware, this is the first report describing a cavernous angioma of the internal auditory canal in the context of familial and multiple infratentorial angiomas.

Patients with squamous cell carcinoma of the hypopharynx (HPSCC) are often seen in advanced stages and have a poor prognosis. The authors analysed 104 patients who had HPSCC and underwent surgery as the primary treatment between 1986 and 1995 in their institute. Of the 104 patients, 83 patients (80 per cent) had advanced T3 or T4 staged and 64 patients (62 per cent) had cervical metastasis. Thirteen patients (13 per cent) had conservation surgery with laryngeal preservation and 69 patients (66 per cent) received post-operative radiotherapy. The five-year overall and disease-specific survival was 47 per cent and 62 per cent, respectively. Recurrence occurred in 38 patients (37 per cent), including 12 (12 per cent) with local, 22 (21 per cent) with regional, and 12 (12 per cent) with distant recurrence. Sixteen patients (15 per cent) had recurrence at multiple sites. The site and size of the primary tumour, neck biopsy before surgery, early post-operative complications, and pathological nodal stage were significant prognostic factors of disease-specific survival (DSS) in univariate analysis. Neck biopsy before surgery and site of primary tumour were significant factors in multivariate analysis. In conclusion, surgical treatment for the HPSCC patients has achieved good local-regional control and survival. Bilateral neck dissection for the tumour across the midline and avoiding neck biopsy before surgery may reduce regional recurrence.

Granuloma annulare is a benign, idiopathic, inflammatory dermatosis characterized clinically by dermal papules and annular plaques. We describe the case of a 40-year-old man who presented with a long history of multiple nodules on the left pinna. Histological examination revealed the typical necrobiotic granulomas of granuloma annulare. The condition predominantly affects the extremities of children and young adults; cases involving the pinna are extremely rare.

Nodular lesions are common in otolaryngological practice, and this case illustrates the need for careful clinical assessment and appropriate biopsy in diagnosing lesions of the outer ear

Spontaneous cerebrospinal fluid (CSF) leak via the oval window is uncommon and can result in recurrent bacterial meningitis. Current understanding of spontaneous CSF otorrhoea is reviewed and a diagnostic algorithm is presented.

A seven-year-old boy presented with bilateral congenital deafness and recurrent meningitis. High-resolution computed tomography (HRCT) of the temporal bone showed a labyrinthine deformity and communication between the internal auditory canal (IAC) and the cochlea. Subtotal petrosectomy with closure of the external acoustic meatus and eustachian tube was performed. Post-operatively, the child had no further episodes of meningitis.

This rare and obscure cause of recurrent childhood meningitis requires a high index of suspicion and the use of diagnostic tools, especially HRCT.

In this preliminary prospective study the value of repeating fine needle aspiration cytology (FNAC) in patients with head and neck lesions was investigated. Few reports exist on the significance of repeating the procedure in head and neck patients. Fifty-seven patients have been sampled twice for the first and second (repeat) FNAC. The second aspirate was performed in the operating theatre under general anaesthesia prior to a surgical procedure. The cytological results were compared with the histology of the 57 resected lesions. It was found that the overall diagnostic results improved after repeating the FNAC. It can be concluded that repeating FNAC is useful and should be considered under some circumstances, especially in the case of non-diagnostic cervical lymph node aspirates.

Background: Concha bullosa, an extensively pneumatized middle turbinate, may obstruct the paranasal sinuses. Messerklinger’s partial lateral turbinectomy is commonly used to debulk the concha bullosa, leaving a raw surface with the potential for adhesions.

Materials and methods: A modified technique of partial lateral turbinectomy is described. A posterior pedicled mucosal flap covers the inferior raw surface of the medial lamella of the middle turbinate. Three-month follow up of a consecutive series is compared with concurrent controls.

Results: Two (7 per cent) of 28 posterior pedicled flap and four (21 per cent) of 19 traditional partial lateral turbinectomies developed mild middle meatal adhesions (p = 0.011). Posterior pedicled flap reduced the need for post-operative cleaning of the middle meatus.

Conclusion: The posterior pedicled mucosal flap is a simple modification to partial lateral turbinectomy that covers the raw surface facing the lateral nasal wall, significantly reducing adhesions and speeding recovery.

One of the most challenging types of nasal fracture is when the nasal pyramid, comprising of the upper and lower lateral cartilages and septum including the vomer, is fractured, impacted and has rotated into the face. This paper describes a technique to elevate the nasal complex and hold it forwards using a Kirschner wire.

Tetanus kills approximately 500 000 people worldwide each year. Widespread immunization has ensured that it is rarely encountered in the United Kingdom. An increase in global travel may increase the likelihood of such encounters in the developed world in the future.

In the non-immunized patient, death from tetanus can be avoided by early recognition and timely intervention. The potential need for airway support and sedation should not be underestimated.

The authors’ case report should increase the awareness of the otolaryngologist when confronted with atypical cases of dysphagia and trismus and provides details of the recommended treatment regime.

It has been shown that computerized sound frequency analysis can be used todistinguish between different snoring sites. The aim of this study was to investigate whether aportable recording method using audiotapes and digital minidisc formats could produce waveformssimilar to a computer recording.

The snores of 12 subjects in their natural sleep were recorded onto audiotape, minidisc and directly onto a computer. For each snorer and recording method 30 snore samples were analysed and their power ratio was calculated indicating the relative amount of sound below and above a set frequency. It was found that the power ratios from audiotape recordings were significantly different to those from computer recordings for all snoring sites (p = 0.0007), whereasthere was no significant difference between minidisc and computer recordings (p = 0.41).

These results indicate that it would be possible to base a portable snore analysis system for site determination on minidisc, but not on audiotape recordings.

A rare case of a smooth muscle tumour in the pharynx is reported, together with histopathological findings. The patient’s psychiatric background and recurrent complaint of a sensation of a lump in the throat all pointed to a psychogenic aetiology, and diagnosis was delayed. The importance of mirror or endoscopic examination of the pharynx is stressed in patients with globus pharyngeus symptoms.

The General Medical Council’s core curriculum model for undergraduate medical training is leading to changes in the way specialist subjects are taught. A postal survey was undertaken to evaluate the current state of undergraduate clinical teaching in otolaryngology in the United Kingdom. Data were received from all 27 medical schools. Six medical schools (22 per cent) do not have a compulsory ENT attachment, although three of these offer an optional attachment. Fifty-eight per cent of all ENT attachments are combined with other specialities including dermatology, ophthalmology and neurology. The average length of time spent with the ENT department during medical school training is one and a half weeks. Forty-two per cent of students do not have a formal assessment of their clinical skills or knowledge at the end of such attachments.

Epistaxis has a reported prevalence of 10–12 per cent in the general population and is thus one of the commonest emergencies in Otolaryngology. We suggest that the patient uses a surgical mask to prevent blood spray during epistaxis management. Utilizing the described technique we have found that protective clothing worn by the healthcare professional is consistently ’blood-free’ atthe end of the procedure. This is in contrast to findings when no facemask is applied.

There have been many frontal sinus stents described in the medical literature. Here we describe the first application of a ureteric pigtail stent to an extensively operated frontal sinus and lateral mucocele cavity. There are two properties of the design of this stent that make it ideal for this case. Firstly, it is self-retaining, eliminating the need for fixation sutures. Secondly, the stent has a considerable available length (220-300 mm between pigtails), allowing ventilation of a distant mucocele cavity.

We report a patient who developed left ear pain, dry cough, and fever. The external auditory canal was tender, swollen, erythematous and full of debris. Later the patient developed widespread tender and red skin nodules and pustules that subsequently coalesced to form plaques. Identical lesions developed also in the external auditory canal and the tympanic membrane of the affected ear. Skin biopsy showed dermal neutrophilia, compatible with the diagnosis of Sweet’s syndrome. Rapid improvement was achieved with prednisone after the failure of antibiotics.

A variety of approaches have been employed for the reconstruction of head and neck defects and most of the techniques involve the use of arterialized vascular flaps alone, or in conjunction with other regional or local tissues. We frequently use a pectoralis major myocutaneous (PMMC) flap in our hospital in addition to other pedicled or free tissue transfers. A PMMC flap is a reliable flap with acceptable complications, needs a small learning curve, takes less time, and does not require additional investment (i.e. microscopes, loops etc). The disadvantages of the PMMC flap is that it has a restricted arc of rotation, gives a cosmetically unacceptable bulk in the neck, it is difficult in females and causes significant shoulder dysfunction. We have made a small improvization in the flap-raising technique which is helpful for the surgeon. This involves utilization of intestinal clamps to hold and cut the pectoralis major muscle.

Ear drops containing neomycin only rarely cause ototoxicity. The authors report on three patients with a tympanic membrane perforation who developed severe ototoxicity after use of eardrops containing 0.35 per cent neomycin. Mitochondrial DNA analysis revealed that there was no A1555G point mutation in these patients. This finding indicates that application of low concentration neomycin to the middle ear can cause severe inner ear damage even in humans who are not hyper-susceptible to aminoglycosides.

This paper reports an unusual case in which aseptic meningitis presented with sudden sensorineural hearing loss (SSNHL) associated with intralabyrinthine haemorrhage (ILH). A seven-year-old girl presented with sudden right-sided hearing loss with dizziness. She did not have a previous history of bleeding disorders. This child was assessed using audiograms and magnetic resonance imaging (MRI). The patient's hearing loss was irreversible. Steroid therapy was not effective. SSNHL associated with ILH can be one of the negative prognostic factors in children.

The larynx functions as a protective valve of the upper airway. An end-tracheostomy represents a risk factor for foreign body aspiration. We describe a case of tracheostomy stoma button aspiration, leading to recurrent chest infection and irreversible lung damage, necessitating a pneumonectomy. This is the first reported case of this kind. This case also emphasizes the importance of patient education and of stoma button design.

The non-recurrent inferior laryngeal nerve (NRILN) is a nerve anomaly that can be associated with an increased risk of vocal fold paralysis. The purpose of this study wasto report three new cases of this anomaly, underline the necessity of recognizing its possibility for the prevention of intra-operative nerve damage and a review of the literature.

Three cases of thyroid surgery associated with right NRILN are reported.

Two patients underwent bilateral thyroidectomy for a multinodular goitre and for a toxic multinodular goitre respectively. The third patient had a right lobectomy and isthmectomy for a thyroid nodule. All patients had identification of the recurrent laryngeal nerve on the left sideand NRILN on the right side. The diagnosis of the NRILN was made per-operatively on all cases. A post-operative computed tomography (CT) scan in two patients, showed a retrooesophageal aberrant right subclavian artery. Post-operatively, all patients had normal vocal fold function on laryngoscopy.

The NRILN is a rare anomaly but overlooking its possibility may lead to severe operative morbidity. This is an additional argument in favour of systematic dissection of the recurrent inferior laryngeal nerve during thyroid surgery.

A unique case is presented of a penetrating injury of the parotid gland and complete transection of the cartilaginous portion of the external auditory canal by a tree branch. A subsequent superficial parotidectomy along with end-to-end anastomosis of the external auditory canal and appropriate antimicrobial therapy was successful. A review of the literature did not reveal any previous similar cases.