The authors describe an unusual case of a primary chondroid chordoma arising from the base of petrous temporal bone. The patient, a young male, presented with a left sided jugular foramen syndrome. The CT findings of a tumour arising from the base of the left petrous temporal bone were confirmed at infratemporal exploration. The clinical and histopathological and immunohistochemical differences between classical (typical) chordoma and its chondroid variant are highlighted. The rarity of primary chordomas at this site is stressed.

This is a modified subtotal laryngectomy. On the tumour-free side of the larynx, some posterior structures, with their neurovascular supply are preserved. The endolaryngeal mucosa is tubed in continuity with the trachea below and projects into the pharynx above. Thus a myomucosal shunt is formed. Air is directed into it by finger occlusion of the tracheal stoma.

The voice production is highly satisfactory. Aspiration is prevented by constriction of the thyroarytenoid muscle which provides a valved upper end of the tube.

The possibility of leaving tumour in the laryngeal remnant is eliminated by careful selection of patients, and re-confirmation of tumour extent intra-operatively and a frozen section.

Eleven such operations have been performed since October 1983 for squamous cell carcinoma, some previously irradiated. None of the patients had local recurrence. Only one had an aspiration problem which later resolved. All acquired a satisfactory voice

Osteoma of external auditory canal is a rare benign tumour. Usually it is found incidentally and often symptomless. Here we have a case of osteoma arising from the anterior wall of the bony external auditory canal, causing ipsilateral temporal headache which was relieved by removal of tumour

Perforation of the tympanic membrane is a common war injury, especially after explosions. Such perforations will normally heal spontaneously under favourable conditions. A small number in whom the defect persists will benefit from closure by myringoplasty. Thirty-four such cases underwent operative repair and were compared with an equal number due to other causes.

Children presenting with ethmoidal mucocoeles are rare. Five children are presented with such findings, and the diagnosis, treatment and possible aetiology discussed.

C. T. scanning was found to be the investigation of choice, while plain sinus X-rays correlated poorly with the presence of disease. Exenteration through an external approach was found to be satisfactory. In two cases drainage obstruction due to congenital abnormality was thought to be the underlying cause, while in four cases there was a strong history of atopy, indicating allergy as a possible reason for mucocoele formation.

The results of 25 years of quasi-routine total parotidectomy performance are shown. At the Department of Otolaryngology of the University of Florence, 582 patients were treated as follows: on 527 occasions by total parotidectomy with facial never preservation; 24 occasions by lateral lobectomy; 27 occasions by total parotidectomy with removal of the whole facial nerve; four times by enucleo-resection of the disease. Benign tumours were 378; primary and metastatic malignant tumours—100; non tumoral lesions—104.

The benign tumours follow-up showed three recurrences only (two pleomorphic adenomas—one of them proved to be an adenoid-cystic carcinoma, and one monomorphic adenoma, which also proved to be an adenoid-cystic carcinoma), respectively 6, 6 and 8 years later. The malignant tumours were also treated by total parotidectomy with adequate management both of the facial nerve and the neck lymph nodes. The results thoroughly justify the nerve preservation, when preserved.

Abstract Adenocarcinoma of the ethmoid sinus is a rare cancer in this country but relatively common in High Wycombe because of the concentration of furniture factories in this area. The management of five cases occurring recently in the High Wycombe area is described and changes in management since 1960 discussed.

A total of 23 patients have been treated endoscopically during the last three and a half years for a variety of diseases in the tracheo-bronchial tree; nine had a tracheal stenosis. Thirteen patients have been treated by resection with a high frequency cutting loop, eleven with a CO2-laser and one with an argon laser. A total of 44 treatments have been performed. Half of the treatments were given because of various malignant diseases.

The results of the treatment of this very mixed group of patients were, as a whole, satisfactory with both CO2-laser and cutting loop. A more precise technique can be applied with the CO2-laser than the cutting loop, though the latter is the more efficient and easy to work with. Care must be taken with the loop because of its greater cutting depth.

The argon laser has only limited use in the treatment of diseases in the trachea.

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.

The middle ear cavity is exposed and vulnerable to waterborne infection in patients with grommets, perforated tympanic membranes and after radical mastoidectomy. Patients suffering from chronic otitis externa and those receiving radiotherapy to the head and neck also have an increased susceptibility to such infections. Many advocate the use of waterproof ear protectors in such patients when swimming. The choice of a suitable ear protector is complicated as many are now available commercially.

This study was therefore designed to evaluate the degree of protection afforded by seven different ear protectors in a group of six swimmers. A very sensitive, original method of water detection was devised incorporating a pH indicator strip.

The results showed conclusively that cotton wool coated in paraffin jelly BPC was the most effective method of ear protection and was found to be comfortable and easy to use. Other methods, including custom-made silicone rubber plugs, were not adequate in sealing the external auditory canal and are considerably more expensive.

The sensorineural hearing loss in 150 patients with chronic otitis media who were treated in the Haifa Medical Center (Rothschild) during a ten year period was studied. There were 124 patients treated with a mixture containing neomycin, polymyxin B and dexamethasone and a control group of 26 patients with dexamethasone only.

All patients were followed up for a period of 1–2 years. Patients with hearing loss due to factors such as previous ear surgery, family history, exposure to noise etc., have been excluded.

The conclusions reached were that there is a relationship between the period of disease and the sensorineural hearing loss and that the local treatment with a mixture containing neomycin + polymyxin B appears to contribute to the worsening of the sensorineural hearing loss in patients with chronic otitis media.

Our numbers are small and further studies must be done, but the fact that currently used ear drops may produce a sensorineural hearing loss should not be ignored.

Fifty insulin-dependent diabetics and 50 non-diabetics without a history of nasal disease have been studied for nasal problems including mucociliary function complicated by diabetes mellitus. For the diabetics, the mean value of nasal mucociliary clearance was considerably decreased and this was more often associated with dry noses but increased pH-values, both of which were higher than those for non-diabetics (p<0.05). As suggested in earlier literature, more aggressive nasal moistening therapy must be recommended for those patients presenting with these conditions in the light of systemic diabetic abnormalities.

Scleroma is a chronic progressive granulomatous disease predominantly affecting the mucous membrane of the upper respiratory tract, endemic in temperate and tropical zone countries including Egypt. Many patients in early stages respond to medical treatment while others do not. In these patients an antileprotic agent Clofazimin (Lamprene®) was tried in 76 patients and the therapeutic results are very promising, especially for the early stages of the disease.

The aim of the study was to examine the incidence of croup in the Swansea area and to determine whether meteorological factors have any effect on the incidence of acute laryngotracheitis requiring hospitalization.

447 patients with a diagnosis of acute viral croup were admitted to the Ear, Nose and Throat Department of Singleton Hospital, Swansea, between January 1st 1980 and December 31st 1984.

There was no significant difference between days with and without croup admissions, with respect to barometric pressure or relative humidity. Maximum and minimum temperatures were significantly lower on days with croup admissions (p>0.001).

Wind direction appeared to influence the number of admissions, which were increased when the wind was from the south-east (p>0.01).

The diagnosis ‘acute;’ mastoiditis is not an unambiguous entity. It contains both ‘classical’ and ‘latent’ mastoiditis. ‘Classical’ mastoiditis was often seen before the antibiotic era, had serious complications and was cured by mastoidectomy. After the introduction of antibiotics, the number of cases of ‘classical’ mastoiditis decreased and was replaced by a more prolonged condition called ‘latent’ mastoiditis. Lately in Oslo, we have seen an increase in numbers of ‘classical’ mastoiditis and at the same time a decrease in the incidence of ‘latent’ mastoiditis. A four year study of patients with ‘classical’ mastoiditis is described.

A large number of non-human mammalian larynges have been studied in an attempt to relate body mass to maximum glottic and tracheal area in order to confirm symmorphism.

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.

Inverted papilloma is an uncommon benign nasal tumour which usually occurs on the lateral nasal wall and is prone to recurrence and malignant change. Inverted papilloma of the nasal septum is rare. A case of inverted papilloma and coexistent squamous carcinoma of the nasal septum in an adult male is described. The biology and treatment of these lesions are discussed.

Advances in audiological, radiological and microsurgical techniques have enabled otologists to diagnose and excise very small acoustic tumours with a low morbidity and mortality. Is this cost effective?

In an attempt to answer this question, an analysis of 66 cases of surgically treated acoustic neuromas is presented. This represents part of a series of skull base procedures carried out at Addenbrooke's Hospital over the last five years. As a result of this work an investigative protocol is suggested. By studying the relative morbidity of early and late surgical intervention in these cases, and by costing the exercise, the justification for early diagnosis and treatment is presented both in financial and human terms.

Facial skeletal morphology was studied by cephalometric analysis in 25 patients with obstructive sleep apnoea syndrome (OSAS) and ten controls. The hyoid bone was more inferiorly positioned in patients (at the level of cervical vertebrae C4-C6) than in controls (C3-C4 level). The height and length of the nasal cavity was normal, while the length of the bony nasopharynx was moderately reduced. The mandibular plane inclination was slightly larger in patients as was the anterior face height. Mandibular retrognathia was demonstrated in six patients (24 per cent), but the angles of maxillary and mandibular prognathism was within normal limits when the group was considered as a unity. Cephalometric analysis is highly recommended as a diagnostic aid in OSAS patients, especially when surgical intervention is considered.