The term ‘tumefactive fibroinflammatory lesion’ has been usedto describe a fibrosclerosing disorder which has a locally destructive nature but is characterized by a benign histological appearance. We report five patients, over a five year period, with such a lesion.

The clinical behaviour and surgical findings suggest the lesion to be an invasive malignancy. However, the histological appearance of an admixtureof chronic inflammatory cells and fibrosis is consistent with a benign condition.

We recommend surgical excision of the lesion as the mainstay of treatment; other studies report the use of steroids and radiotherapy.

This study describes the treatment and survival of 54 patients with gross recurrent laryngeal carcinoma after radiotherapy. Twenty-six patients were treated with local ultra-high frequency hyperthermia in combination with radiotherapy and chemotherapy (HRCH). Twenty-eight control patients were treated with radiotherapy and chemotherapy (RCh). Eight patients (33 per cent) in HRCh showed a three year survival but no patient in the RCh group. At two years 18 patients (75 per cent) in HRCh and two (7 per cent) in RCh survived.

Growth of the cricoid ring in infants is studied. In the first two weeks of life a small ring seems correlated with the fact of early infant death. Therefore we suggest that mortuary specimens at this age are not a reliable guide to the size of the cricoid in thriving infants.

Rates of growth from ages of two weeks to three years are given for the specimens examined. Comparison with similar measurements carried out in England show that the specimens collected here were systematically smaller for a given age.

Removal of the olfactory bulb was performed on rats in an attempt to elucidate the processes of olfactory dysfunction following head injury. Degeneration and regeneration of the olfactory mucosa were examined, histopathologically and immunohistochemically. We used antisera to olfactory marker protein (OMP) and neuron specific enolase (NSE) as a marker of the mature olfactory receptor neurons. Following rapid degeneration after bulbectomy, the olfactory receptor neurons regenerated. OMP and NSE containing cells re-appeared 49 days later. However, the cell population of the neuroepithelium did not revert to the numbers observed in the non-operated neuroepithelium, even three months later. The lack of a connection between regenerated axons and the olfactory bulb may result in immature neuronal replacement and reduce the number of olfactory receptor neurons.

Forty patients presenting with watery rhinorrhoea as their main complaint were entered in an open trial of long-term intranasal ipratroprium bromide. Fourteen of these (35 per cent) found it to be beneficial and completed one year of treatment. Side-effects were seen in 28 patients (70 per cent) but these were local and mild in nature. All resolved during the trial as patients adjusted the dosage to individual severity and frequency of symptoms. No significant systemic effects were noted during the course of therapy. Ipratroprium is a useful drug in the treatment of watery rhinorroea and appears safe for long-term use.

An audit was carried out to assess the acceptability of long distance travel for elective tonsillectomy and adenoidectomy. Seventy nine children travelled 70 miles with their father or mother to P. A. H. from Mid Glamorgan where the E.N.T. waiting list delay for tonsillectomy was some two years.

Most of the families who were offered the travel arrangements agreed and from the results of the questionnaires answered by the first 50 families, it was shown to be a successful exercise as both the children and parents were very happy with the arrangements and there were no complications.

The near field monitoring of an auditory evoked response from the cochlear (electrocochleography) is a tried and trusted clinical tool. Conventional techniques for performing electrocochleography are cumbersome to use and frequently uncomfortable for the patient. We present a simple, modified technique which provides more flexibility with regard to where and when electrocochleography may be performed and also improves patient comfort during the test.

Sudden onset sensorineural hearing loss is an otological emergency. Although deafness is recognised as being associated with polyarteritis nodosa (PAN) only very rarely does it herald the disease. We describe a case of bilateral, sudden onset vestibulo-cochlear failure which with thorough investigation proved to be the presenting complaint of PAN.

This diagnosis enabled definitive management of a multi-system disorder and resulted in an improvement of the initial symptom with the chemotherapeutic regime discussed.

We review the involvement of PAN in deafness and hope this case will remind otolaryngologists of the need for full investigation of the above mentioned emergency, in an attempt to discover and hence direct management towards a specific underlying pathology.

Ten cases of malignant external otitis in children have been reported hitherto. These are reviewed, and an eleventh case, a three-month-old infant associated with genetic granulocytopenia, is presented. On the grounds of the reported paediatric cases, the erudition in childhood is compared with the more common form in the adult, and is found to be much less linked with diabetes mellitus and to have a far better prognosis, with practically no mortality.

Nasal airway resistance due to uncomplicated DNS was examined in 43 patients, and the results compared with those obtained following corrective surgery. The patients were examined independently by the two authors using a strict examination protocol. Rhinomanometry was carried out pre- and post-operatively at rest and after exercise assessing the worst and the better breathing nostrils separately. The results show that both resting and post-exercise nasal resistance was reduced following septal surgery.

Adenoid enlargement is uncommon in adults and because examination of the nasopharynx by indirect posterior rhinoscopy is inadequate, many cases of enlarged adenoid in adults are misdiagnosed and accordingly maltreated.

This study was conducted on 35 cases of enlarged adenoid aged between 20 and 42 years. The nasal endoscope was utilized to identify the adenoid mass. Adenoidectomy under transnasal endoscopic control was performed and all the excised material was sent for histopathological examination. Adenoidectomy resulted in marked improvement in 94 per cent of cases without major complications. Histopathological examination revealed non-specific inflammatory reaction in 15 cases (43 per cent), pure reactive changes, predominantly follicular hyperplasia, in two cases (6 per cent) and mixed pattern in 18 cases (51 per cent). Endoscopic follow-up for an average 17 months identified recurrence in only two patients. It was concluded that enlarged adenoid tissue in adults has some histopathological differences from that in children and adenoidectomy under transnasal endoscopic control is safe and reliable.

Isolated visual dysfunction with or without proptosis is rarely described as a sign of benign sphenoethmoidal lesions. Five patients with benign swelling of the sino-orbital region and related visual defects are reported. Cases include one patient with fibrous dysplasia, two patients with mucocoeles and two patients suffering from aspergillosis of the sinuses. A review of the literature and discussion of the cases is presented.

It has been suggested that children undergoing tonsillectomy would benefit from an intravenous infusion, to counteract the period of pre-operativefasting combined with the blood loss at operation.

A prospective study of 50 children undergoing tonsillectomy was undertaken. The children were randomly allocated into two groups, one to receive an infusion and a control group.

There were no significant differences between the two groups, although the children with an infusion had a longer mean post-operative stay.

There would seem to be no role for routine intravenous fluid replacement in children undergoing uncomplicated tonsillectomy.

The method of surgical treatment for benign tumours of the parotid gland has not yet been rationalized, but many authors recommend parotidectomy as the most appropriate procedure. A series of 289 operations for parotid swellings is reported; the majority of mixed and Warthin's tumours underwent enucleation without either complications or recurrence. The rationale of parotidectomy versus enucleation is discussed but in fast growing, deeply infiltrating and recurrent tumours, parotidectomy appears to be the best choice. In the other group of more commonly occurring tumours, enucleation represents a reliable time saving option.

In evaluating the long term results of surgical treatment of Reinke's oedema, there has been found to be a high incidence of recurrence. The recurrence rate is significantly lower amongst those patients who gave up smoking after treatment. A group of patients with chronic Reinke's oedema were followed for six months. Maximum efforts were made to help the patients to stop smoking. Twenty-nine patients entered the study, but only eight of them (28 per cent) refrained from smoking; all were women (39–70 years) and all experienced reduced discomfort, although none of the voices were restored to normal. Diffuse laryngitis disappeared completely, but the oedema did not disappear entirely in any patient. Before treatment of chronic Reinke's oedema patients must be well advised and informed, and if surgery is decided upon, they must be urged most strongly to stop smoking, if they wish to enhance the possibility of satisfactory long-term results.

The current investigations of choice for a suspected glomus tumour are either direct or indirect angiography to include digital subtraction followed by computerized tomography (CT) or magnetic resonance imaging (MRI) or, if available, CT and MRI with gadolinium alone. Although these modalities confirm the diagnosis and give anatomical information to facilitate accurate staging, they do not provide functional data. The use of radionuclide scintigraphy can add an extra physiological dimension to glomus tumour imaging.

Iodine-131/123 metaiodobenzylguanidine (MIBG) is a tumour imaging agent which has been used to diagnose head and neck neuroendocrine tumours to include paragangliomata and medullary carcinoma of the thyroid (MCT). However, it is expensive and the new head and neck tumour imaging agent technetium-99 m (Tc99m) (v) dimercaptosuccinic acid (DMSA) has superceded it as the imaging agent of choice to evaluate MCT. We report a patient with a glomus jugulare tumour which was evaluated with I131/I123-MIBG and Tc99m (v) DMSA. The tumour was functional and is the first reported case exhibiting positive accumulation of both I131-MIBG and Tc99m (v) DMSA. The patient was subsequently treated with a therapeutic dose of I131-MIBG. The significance of these results is discussed.

A previously unreported association between aniridia and congenital sensorineural deafness is reported in a family in which the father and one child possess the combination of abnormalities. One of the remaining two children also has a congenital sensorineural hearing loss without any occular abnormalities.

Heterotopic brain tissue is a rare cause of symptoms in neonates in whom it may present with respiratory obstruction. In infants it may produce unilateral nasal obstruction due to a nasal ‘polyp’ or cerebrospinal fluid rhinorrhoea with an associated risk of meningitis. It is exceedingly rare in adults but may nevertheless be a cause of significant morbidity as this case demonstrates.

A new application of EMLA cream is described. Relief of pain in otitis externa is difficult and systemic analgesics for this localized condition are often ineffective. Meticulous cleaning of the external auditory meatus is an essential step in the treatment. EMLA cream is an effective analgesic which can be used to relieve pain and anaesthetize the external auditory meatus to allow cleaning in patients with intact tympanic membranes.

Auditory brainstem responses are an established technique in the diagnosis of acoustic neuroma. In several reports abnormalities are shown to occur in the contralateral ear.

That these abnormalities recover has been demonstrated, but only in terms of changes in inter-peak latency. In only one case has the waveform trace showing this been published. We present a case in which a highly abnormal wave form was obtained from the ear contralateral to a large acoustic neuroma. Following excision of the lesion, the waveform reverted to a normal pattern. The literature on the subject is reviewed.