Cochlear implantation is usually a safe procedure but, as in most surgical interventions, it can carry some risk of complications. These can be divided into major and minor that, in turn, in turn can present early or late. This case report highlights a potential late, major complication of cochlear implantation namely extrusion, which was averted by prompt intervention. The patient presented with a three months’ history of otalgia some six yearsafter successful implantation. The posterior half of the tympanic membrane was found to be retracted on the electrode, which appeared to be on the point of extruding through the drum. A tragal cartilage myringoplasty was performed to separate the electrode from the medial surface of the tympanic membrane. There was immediate and lasting relief of the otalgia, the electrode was well protected and performance with the device was unchanged.

The authors recommend reinforcing an atrophic tympanic membrane at the time of the cochlearimplantation by a cartilage graft to avoid this potentially serious complication. The case alsohighlights the need for regular otoscopy for all implanted patients.

Packing of the nose with a suitable material remains a popular method of treating epistaxis. The authors report a serious complication of a new design of nasal pack; Rapid Rhino®, which was swallowed during the treatment of a patient with epistaxis, resulting in bowel perforation.

An eight-year-old boy with Treacher Collins syndrome was fitted with a bone-anchored hearing aid. The audiometric result was excellent. Two years later, the abutment began to loosen and could not be tightened. It was thought that a new fixture would be required, with loss of use of the aid for three months. At surgery, bone was found to be growing over the hexagonal joint between fixture and abutment. A simple and rapid solution to this problem is described.

A facial nerve palsy, as a result of middle-ear high pressure, is a rare complication of sub-aqua diving. It may occur as a result of an acute pressure change in the middle ear during ascent in those patients who have experienced difficulty equalizing their middle-ear pressure during the prior descent. We present the case history of this occurring in a 21-year-old diver and discuss the pathophysiology, management and the previous literature. The correct diagnosis of this condition is important if unnecessary, and potentially hazardous, recompression treatment is to be avoided.

Metastasis is a feature of malignant neoplasms. Although rare, metastasizing pathologically benign mixed tumour has been reported. This report describes a 33-year-old woman with multiple lung metastases from mixed tumour. A small preauricular mass had been removed 23 years earlier. Six years later, the patient had the same symptom; the recurrent mass was resected. She was not aware of the exact pathological diagnosis of the previous tumours. One of the most common features of metastasizing mixed tumour is recurrence at the primary site. Inadequate resection of the primary tumour is often associated with metastasis. Thus, it is important for the head and neck surgeon to be aware of the concept of pathologically benign metastasizing mixed tumour and the importance of adequate surgical procedure.

Ectopic lingual thyroid glands may occasionally undergo massive hypertrophyand be a source of airway obstruction. Securing the airway prior to surgery in such cases may be difficult. In the present paper, we report on two cases of obstructive ectopic lingual thyroids which were successfully managed endoscopically using CO2 laser. The use of CO2 laser for removal of ectopic lingual thyroid tissue offers advantages over traditionalsurgical techniques. In our opinion, removal of an appropriate amount of gland to secure an adequate airway is all that is required in most cases.

This paper presents a combined procedure for the management of intractable benign paroxysmal positional vertigo (BPPV) and profound hearing loss in a patient with far advanced otosclerosis. The procedure comprised of a posterior semicircular canal occlusion and cochlear implantation as one combined procedure in the same ear. The combined approach added little to the operative morbidity and proved effective in this patient’s management. A search of the literature reveals this to be a unique case.

Fusobacterium necrophorum is implicated as an aetiological agent in a variety of necrotic diseases, such as Lemièrre’s syndrome (LS) in humans. LS was initially described as septic thrombophlebitis of the internal jugular vein secondary to an acute oropharyngeal infection. Other primary sources of infection include parotitis, otitis media, sinusitis, odontogenic infection and m stoiditis. In the pre-antibiotic era LS carried a high mortality. This has been reduced as a result of the widespread use of antibiotics, butthere is still a definite morbidity and mortality associated with infection with this virulent organism. We report three cases of complicatedotitis media caused by Fusobacterium necrophorum. The patients were treated successively with intravenous metronidazole and surgery.

Primary hyperparathyroidism during pregnancy carries significant risks to both mother and fetus. Parathyroidectomy remains the only definitive treatment for the condition. The timing of surgery remains controversial, with ongoing debate regarding the safety of surgery during the third trimester. A case of symptomatic primary hyperparathyroidism treated by parathyroidectomy in the third trimester is described. The clinical features, investigations and treatment options are discussed.

Antrochoanal polyps were first documented in the 18th century. They represent one of the most common types of nasal polyps in children without cystic fibrosis. Only a few reports on children who had a history of snoring due to an antrochoanal polyp and only two cases where the antrochoanal polyp caused documented obstructive sleep apnoea (OSA) have been published so far. This report adds a third case of paediatric OSA induced by an antrochoanal polyp in a 12-year-old boy. After endonasal endoscopically-controlled polypectomy and a recurrence, transoral osteoplastic antrotomy in combination with endoscopic endonasal polypectomy eliminated the antrochoanal polyp and OSA was resolved. The authors have reviewed essential historical aspects about children suffering from snoring and/or OSA caused by an antrochoanal polyp.

Sebaceous carcinoma of the nose is rare. Here the authors present a case of a 71-year-old man who presented with a mass in the right nasal vestibule. This was removed and a nasolabial flap used to reconstruct the defect. Histology revealed a sebaceous carcinoma. At follow-up, three months later, a new lesion had appeared in the opposite nostril which when removed proved to be a second sebaceous carcinoma. This multi-focal presentation in the nose has not been described in the literature before.

We report a case of sudden hearing loss in a patient with acute exudative tonsillitis, occurring 15 minutes after the intramuscular administration of penicillin. Audiological evaluation documented a profound sensorineural hearing loss of the cochlear type. The mechanism of the hearing loss was probably an immediate hypersensitivity (type I) allergic drug reaction. Penicillin is used frequently for the treatment of several infections. Allergic reactions to penicillin are well known and include urticaria, maculopapular exanthems, angio-oedema, bronchospasm and anaphylaxis, but sudden hearing loss has never been recorded.

Cochlear implants have transformed the treatment of sensorineural hearing loss. They have few major complications. The authors describe the case of a man fitted with a cochlear implant who suffered a postoperative subdural haematoma. The haematoma is thought to have been caused by bleeding from emissary veins opened by the drill passages used to anchor the sutures for the receiver/stimulator. The authors have abandoned tie down sutures in cochlear implants, preferring an appropriately deep well with squared-off rims, which would secure the implant in place. They have had no further complications of this nature.

Precise bimanual microsurgical excision of sessile, thin benign epithelial lesions of the vocal folds can be difficult. During microlaryngeal surgery, the potential risks of over-excision and under-excision are of major concern. We introduce a microsurgical technique using horizontally-opening curved microforceps and microscissors, instead of the conventional vertically-opening microinstruments, to remove vocal nodules and simple epithelial hyperplasia. The treatment results were satisfactory, with 208 (90.8 per cent) of patients retaining a satisfactory/normal (G0) voice. No patient had a worsened voice after the procedure. This microsurgical pressing excision technique is an alternative precise method for microlaryngosurgery.

Chondrosarcomas (CSA) of the temporal bone are rare primary malignant tumours that are slow growing, but locally aggressive. The management of CSAs involving the temporal bone is challenging and necessitates a multidisciplinary approach in a tertiary referral unit well practised in skull base surgery. Their management with particular reference to modes of presentation and treatment strategies has been reviewed here.

There has been a steady increase in the number of cases of methicillin-resistant Staphylococcus aureus (MRSA) otorrhoea; this is a growing concern. The purpose of this study was to evaluate the efficacy of topical vancomycin treatment in patients with MRSA otorrhoea. Fifty-five patients with MRSA otorrhoea were prospectively enrolled into the study. Thirty-five patients were treated with vancomycin eardrops as outpatients. The concentration of the locally prepared vancomycin solution was 25 mg/ml. The dose of vancomycin was two drops three times daily for 10 days. As a control group, 20 patients were treated with gentamicin 0.3% solution. Data were analysed by the Mann-Whitney U test to compare the efficacy of vancomycin eardrops and gentamicin eardrops. In the vancomycin group, the otorrhoea was significantly reduced in 33 ears (94%); in the gentamicin group, in four ears (20 per cent); this reduction was statistically significant (P < 0.03). The use of topical vancomycin treatment was effective for patients with MRSA otorrhoea refractory to conventional antibiotic treatment.

Postauricular cutaneous mastoid fistula is a rare condition. The cutaneous mastoid fistula is a very rare complication of chronic suppurative otitis media. The fistula tracts are typically difficult to manage because of the surrounding necrotic skin edges. We describe an unusual case of a postauricular cutaneous mastoid fistula and outline the surgical technique used for closure.

Atrophic rhinitis is a chronic inflammatory disease of the nose. The aetiology of primary atrophic rhinitis is not yet known, although secondary atrophic rhinitis is known to be associated with chronic granulomatous diseases such as tuberculosis and leprosy. The authors report a case of atrophic rhinitis, which was a presenting feature of a rare genetic disorder known as Christ-Siemens-Touraine syndrome, also known as anhidrotic ectodermal dysplasia.

The authors report a novel treatment of a case of type I laryngeal cleft diagnosed in an adult. They describe a technique of endoscopic obliteration of the posterior commissure defect. Initially, a test implant of starch and adrenaline was used, followed by permanent staged injections of Bioplastique™ to the posterior commissure. This rare congenital anomaly usually presents in childhood but late presentation should be considered when adults present with lifelong dysphonia especially when associated with gastro-oesophageal reflux disease.

Peritonsillar abscess formation is an uncommon complication of infectious mononucleosis (IM). Early case reports implicated corticosteroids in the development of such abscesses, however, subsequent studies suggested that these drugs do not promote the formation of abscesses at several sites outside the central nervous system. It has recently been demonstrated that zwitterionic polysaccharides, in bacterial capsules, form complexes with CD4+ T lymphocytes leading to abscess formation. A patient is presented who developed peritonsillar abscess a few days after initiation of corticosteroid therapy for IM; the medical literature was reviewed in respect of this subject. It appears that the occurrence of these abscesses in IM is not strongly linked to corticosteroid treatment. The authors, therefore, recommend that steroids should not be withheld from patients with severe IM on the basis that they may precipitate the development of peritonsillar abscess.