Lymphangiomas are rare benign lymphatic tumours found predominantly in the head and neck region. A case of a cavernous lymphangioma isolated to the sphenoid sinus is described. The authors emphasize the extreme rarity of the isolated sphenoid lymphangioma, as to their knowledge this is the first report in the English literature.

Complications following stapedectomy are the most common cause of litigation involving otological cases in the USA. Manipulation and placement of the prosthesis during a stapedectomy may have a profound effect on the final hearing results. Concerns have been raised over the reduced number of cases, training of residents, and the maintenance of the necessary skills to achieve consistently good results.

Temporal bone dissection is an important adjunct to developing the required skills to perform stapedectomies. However the reduced availability of specimens limits their use for teaching or practising the procedure.

In order to circumvent these problems an inexpensive and easily constructed middle-ear simulator has been developed based on materials readily available in any ENT ward. It is believed that this might help trainees develop the necessary skills to master the procedure.

Charcot-Marie-Tooth (CMT) disease or hereditary motor and sensory neuropathy (HMSN) is a relatively common neurological syndrome, which has seldom been associated with hearing dysfunction, particularly sudden sensorineural hearing loss (SNHL). Families with autosomal dominant, autosomal recessive and X-linked forms of inheritance have been described.

Sudden sensorineural hearing loss is a frustrating and frightening condition, especially if the hearing loss is bilateral. Regarding the site of the lesion, the evidence from the literature on HMSN suggests that either the VIIIth nerve or central auditory pathways are primarily involved in patients with hearing loss.

We report the first case in the English literature of a patient with Charcot-Marie-Tooth type II disease presenting bilateral SNHL in the course of his disease. The patient was hospitalized for 15 days, and undergoing treatment without any audiological improvement. Detailed clinical, audiological and laboratory examination was performed.

The aetiology and prognostic indicators of bilateral SNHL are discussed, as well as, the incidence of hearing loss in CMT patients.

This random survey was to determine the flexible nasopharyngoscope disinfection practice employed by South African otolaryngologists and to establish whether a breach in the disinfection process exists. The study also aimed to identify organisms most likely to be transmitted via endoscopy and to propose a protocol for the disinfection of the flexible nasopharyngoscope.

A questionnaire regarding disinfection techniques used for the flexible nasopharyngoscope was sent to 90 otolaryngologists in South Africa. All provinces were equally represented in the survey.

Forty-five otolaryngologists out of a total of 90 participated in the study. Many of the otolaryngologists had no access to a flexible nasopharyngoscope and were therefore not included in the study. Fewer than 50 per cent of the 45 surgeons washed the instrument with soap/detergent and water after use. Only 42 per cent of surgeons used a FDA-approved disinfectant, 52 per cent of which immersed the scope for a shorter period than the recommended contact time. Of the 58 per cent using non-FDA-approved products, 33 per cent used only a 70 per cent Isopropyl alcohol wipe, without immersion of the scope in disinfectant solution. The remaining 25 per cent used non-FDA-approved disinfectants either by wiping or limited immersion of the scope. Of the 45 surgeons, 49 per cent used a different method of disinfection for high-risk patients.

Strict guidelines have been proposed for the disinfection of this semi-critical device by the Association of Professionals for Infection Control (APIC) and the Centers for Disease Control (CDC). These guidelines are currently not being followed by many South African otolaryngologists. There is therefore a real risk of transmitting infectious diseases, especially tuberculosis, via endoscopy.

Chondrosarcomas of the larynx (CS) are uncommon and predominantly affect the cricoid cartilage. In the larynx they have a distinctive biological behaviour and require individual treatment. A retrospective study was made on three cases of CS, all presenting with compromise of the upper respiratory tract. The medical history varied from several weeks to six years. Correct diagnosis required open resection of the lesion in all cases. Due to intra-operative findings, all patients underwent total laryngectomy. CS grow slowly and are therefore frequently diagnosed late in the course of the disease. A subglottic bulging of the mucosa should indicate high-resolution-computed-tomography of the larynx to exclude affection of the laryngeal framework. Correct diagnosis of laryngeal cartilaginous tumours requires a complete examination of the entirely resected tumour. Only extended and de-differentiated CS indicate further radical surgery, the remainder call for conservative surgical management.

A case of Wegener’s granulomatosis (WG) presenting with hearing loss and right facial nerve palsy is reported. The definitive diagnosis was based upon clinical data and serum cANCA and AECA detection. Early assessment of WG prevented surgical facial nerve decompression to treat a chronic otitis media complication. Immunosuppressive therapy with steroids, cyclophosphamide and methotrexate was required for relief of clinical symptoms and cANCA negativity as an expression of disease remission. The effectiveness of co-trimoxazole for preventing relapses of WG is discussed.

Argon plasma coagulation (APC) is based on the principle of ionized argon creating a conductive plasma between an activating electrode and a tissue surface. To date, its use in tonsillectomy has not been extensively examined. The purpose of this randomized controlled trial was to assess the clinical efficacy of APC as a tool for this common surgical procedure. Forty patients were randomized into two groups - treatment A (conventional tonsillectomy, n = 20) and treatment B (APC tonsillectomy, n = 20). Trial end-points included a) operative time, b) intra-operative blood loss, and c) objective assessment of post-operative pain, by completion of a visual analogue pain score chart, over a two-week period. Thirty-one patients were available for analysis. There was a statistically significant reduction in the intra-operative blood loss with treatment B (p = 0.02). There was no statistical difference between both groups for the other outcome measures. First clinical experience with this treatment modality shows that it is an attractive alternative to conventional tonsillectomy and may offer possible benefits.

Aspiration of a foreign body is a recognized cause of accidental death in children. Paediatricians are aware of the symptoms of inhaled foreign bodies in the lower respiratory tract. However, symptoms which suggest impaction in the larynx do not appear to raise the same index of suspicion of a foreign body. One case of laryngeal foreign body is described with a delay in diagnosis of five days. The clinical presentation, investigations and management are discussed.

Post-intubation laryngeal dysfunction is well documented. Both common and rare patterns of injury have been described in the literature. An unusual pattern of intubation injury is described in this case report. The different patterns of post-intubation laryngeal injury are discussed as well as the possible aetiology in the case described.

Hypoplasia or absence of the epiglottis in an adult is a rarely reported congenital anomaly that usually occurs in association with congenital anomalies of other organ systems. Most epiglottic anomalies usually present in infancy and early childhood with respiratory and feeding problems and the affected individual dies shortly after birth due to multiple congenital anomalies. We present a case of congenital absence of the epiglottis and false vocal folds with hypoplastic maxillae in an adult.

Arachnoid cysts (AC) often present with symptoms depending on their anatomical location within the skull; while supratentorial cysts grow causing relatively few symptoms, infratentorial ones may impair liquor circulation at the level of the fourth ventricle, giving rise to intracranial hypertension, or may stretch the complex nerve network in the cerebello-pontine angle. We report the singular clinical history of a 54-year-old male, who suddenly began to feel dizzy while sitting at his workplace, complaining of left tinnitus and aural fullness, in a classic clinical picture of Ménière’s disease. The anomalous findings at otoneurological examination (markedly the left deviation at the Fukuda test) made a magnetic resonance image (MRI) scan mandatory and a huge AC was found in the left fronto-parietal lobe. The mass provoked an evident clockwise rotation of the brainstem that we suppose to be the cause of acoustico-facial bundle stretching explaining the vestibular symptomatology.

Facial nerve neuromas occur throughout the course of the facial nerve and its branches, however lesions occurring on the chorda tympani branch are exceptionally rare.

We present a case where the diagnosis was made intra-operatively; the patient was pre-operatively thought to have had a cholesteatoma.

Total resection is the treatment of choice for these cases. Early diagnosis, aided by high resolution computed tomography (CT) scanning, will facilitate complete excision without damage to the facial nerve itself or the ossicular chain. The slow growing nature of the neuroma is likely to allow compensatory mechanisms to occur without the patient experiencing dysgeusia. As with any rarity the diagnosis can only be made with a high index of suspicion.

We describe a new technique for removing anterior vocal fold lesions, which cannot be visualized with conventional suspension laryngoscopy. These situations are rare and the only alternative surgeons have had previously is an open laryngeal procedure. The technique we describe involves the use of a laryngeal mask airway (LMA), a flexible bronchoscope with biopsy channel, a 400 μm laser fibre and KTP/532 nm laser. This method was used to treat two patients in whom conventional suspension laryngoscopy had previously been attempted and abandoned.

Inner ear involvement with sensorineural hearing loss (SNHL) has been reported in many autoimmune disorders including ulcerative colitis. The pathogenetic mechanism of hearing loss in ulcerative colitis is thought to be immune mediated. Diagnostic tests are being developed to identify inner ear autoantibodies, that may be the cause of such hearing loss. The only test that is currently available for clinical use is the Otoblot test. This, however, tests only for antibodies against bovine heat shock protein 70 which is only one of the many cross-reacting proteins against the inner ear in suspected immune-mediated hearing loss. The clinical response to steroid therapy is thus the mainstay in the diagnosis of immune-mediated hearing loss. This paper presents a series of patients with clinically suspected autoimmune hearing loss. Diagnostic assays for this condition are discussed along with a review of the recent advances in the pathogenesis and laboratory diagnosis of immune-mediated sensorineural hearing loss.

Foreign bodies of the upper aerodigestive tract are common problems dealt with by the otolaryngologist. Among all foreign bodies in the oesophagus, an open safety pin still presents a challenge for the ENT specialists because of its propensity to pierce the oesophagus and surrounding structures. We present an interesting case of a long-standing foreign body i.e. an open safety pin, which, after piercing the hypopharynx, caused fatal common carotid artery rupture.

Fine needle aspiration test is a useful tool in the investigation of head and neck masses, be they of salivary gland, lymphoid, thyroid or other (branchial cyst) origin. Some practical aspects of this procedure are presented.

The current incidence of missile injury to the temporal bone (MITB) is very low in the United Kingdom. However, the increasing frequency of firearm violence in Britain suggestsa greater risk of occurrence. This, along with the devastating potential sequelae of MITB (facial palsy, dead ear, intracranial damage, major vascular injury and cosmetic disfigurement), requires otolaryngologists to be conversant with all aspects of their management. The risk of major complications is much higher with MITB than with temporal bone injury following blunt trauma, and surgical management is, therefore, much more common. We present one such case, and review the literature outlining the pathogenesis, clinical features, and recommended management.

An atypically sited thyroglossal cyst in a 69-year-old woman is described in this report. The cysts may be located in the intralingual, suprahyoid, thyrohyoid or suprasternal region. The intrahyoid location is rare. The diagnosis was confirmed by computed tomography (CT). Surgical procedure should be indicated in intrahyoid thyroglossal duct cyst cases.

This prospective study assessed the advantages and problems associated with converting a patient using an older generation non-indwelling voice prosthesis to a newer generation indwelling voice prosthesis, in this case the Provox®2. The voice characteristics of each patient were measured using the old and then the new voice prosthesis. Technical aspects of the insertion of the indwelling prosthesis were noted. Each patient completed a questionnaire after a period of use with the indwelling prosthesis.

Changing the prosthesis was simple and uncomplicated in 15 of 17 patients. Acoustic analysis showed improved parameters with the indwelling prosthesis, but no perceptual difference between the two prostheses. The questionnaire revealed that most patients preferred the indwelling prosthesis.

Replacing a non-indwelling with an indwelling prosthesis is technically simple, leading to improvement in voice quality and patient satisfaction. It may be reasonable to offer this choice to patients currently using an older generation non-indwelling voice prosthesis.

Paranasal sinus mucoceles are benign, locally expansile cyst-like masses that are filled with mucus and lined with epithelium. Less than one per cent of them involve the maxillary sinus. Most of these are late complications of a Caldwell Luc procedure. A case is presented of a 31-year-old woman with a maxillary sinus mucocele who had undergone a Le Fort I maxillary advancement procedure 15 years previously – a complication never previously reported.