Medial meatal fibrosis is a rare entity which is linked to inflammatory and traumatic factors. This pathology significantly benefits from surgical management. Criteria for achieving successful results are strict and concern the complete removal of the fibrous tissue and covering of the bony canal with skin graft. The aim of this paper is to present our experience with this rare pathology and to discuss current approaches.

Grafting of the tympanic membrane (myringoplasty) has traditionally been performed as an in-patient procedure in the UK. We have performed day-stay myringoplasty on 21 consecutive patients (15 adults and six children) under general anaesthesia using an underlay temporalis fascia graft. In 18 cases there was complete healing of the tympanic membrane and in three cases the patients developed perforations at four weeks. This success rate is consistent with previously reported studies. All patients were discharged on the day of admission with no major complications.

We have compared the results with a group of patients having the same operation as an in-patient and have concluded that day-stay myringoplasty under general anaestheia is as safe and effective as in-patient surgery for the majority of patients.

An animal model has been devised to allow trainees in nasal and sinus endoscopy to develop basic instrument handling and psychomotor skills, without risk to patients.The sheep's head obtained from the abattoir was modified slightly to simulate more closely the human situation. The model permits nasendoscopy, foreign body removal, septoplasty, turbinate reduction, frontal and maxillary sinoscopy, antrostomy and an epistaxis exercise. To date the tissues have been used freshly thawed, and must be used on the day of preparation.

Five patients with choanal atresia were treated, using a trans-nasal endoscopic Holmium:YAG laser. The age of patients ranged from 15 months to 53 years. The nasal endoscope provides excellent visualization. The advantage of the Holmium:YAG laser is its fibre-optic delivery, allowing the laser to be hand-held, giving greater precision. Good nasal airways were achieved in four out of five cases with a single treatment. The procedure was found to be safe, quick, with minimal morbidity and a shorter in-patient stay.

Control of bleeding vessels by suction cautery under endoscopic vision was used on 38 patients suffering from posterior epistaxis. Twelve patients also required the insertion of nasal tampons at the end of the cautery procedure. Eight patients, six of them hypertensive, had recurrent epistaxis post-operatively. Five patients needed further cautery in order to control the bleeding. Three patients required temporary balloon tamponade, and a single patient had internal maxillary ligation. Temporary palatal numbness in three patients was the only post-operative complication. Otherwise, the technique has the potential advantages of simplicity, safety, effectiveness and simplified post-operative care.

Thirty-six patients with acute laryngeal trauma are presented. Sixteen patients had peace-time and 20 had war injuries. Peace-time injuries were mostly due to car accidents, violence and suicide using a knife, whereas the war injuries were caused by shell and mine fragments.

Nine patients were treated conservatively (eight peace-time and one war-time) and 27 by surgery (eight peace-time and 19 war-time).

Surgical experience showed that acute laryngeal trauma must be treated within the first 24 hours after injury. Primary treatment must be a definite one. In that way complications and uncontrolled healing can be successfully avoided.

In an attempt to analyse the proliferative activity in benign and malignant laryngeal epithelial lesions, and to determine the relationship to their histologic grade, we studied the expression of proliferative cell nuclear antigen (PCNA) and Ki-67 antigen on 20 squamous carcinomas, and on 30 biopsies of epithelial hyperplasia categorized according to the Kambiˇ-Lenart classification into simple, abnormal, and atypical hyperplasias. In simple hyperplasia, both antibodies stained the nuclei of the occasional cells in the basal layer. In abnormal hyperplasia (mild dysplasia), positive cells occupied up to a third, and in atypical hyperplasia (moderate and severe dysplasia) they occupied from two-thirds to the entire epithelial thickness. In squamous carcinoma, we have found a statistically significant correlation between its grade and the percentage of Ki-67-(p<0.01) and PCNA-(p<0.00001) positive cells. Our results suggest that the proliferative fraction progressively increases with the degree of epithelial hyperplasia and the grade of carcinoma. We conclude that the patterns of immunoreactivity to PCNA and Ki-67 antigen correspond to the histologic grade of both benign and malignant epithelial lesions of the larynx. This method should be regarded as a useful adjunct to traditional histological techniques allowing more objective grading of benign and malignant epithelial lesions.

A prospective randomized study was carried out to assess the post-tonsillectomy morbidity of the selective diathermy technique as opposed to the ligation technique. One hundred and five patients had one tonsillar fossa haemostasis secured by unipolar diathermy and the opposite side by ligation technique. There was significantly less pharyngeal pain on the diathermy side in the first post-operative day. However, there was no significant difference between the two sides, both in pharyngeal discomfort and otalgia for the rest of the post-operative period. There was no difference in the incidence of haemorrhage between the two techniques.

The multi-cytokine inducer OK-432 is a pulverized preparation of the low-virulence SU strain of Streptococcus pyogenes of human origin. A reduction of the tumour mass in the OK-432-injected areas was observed in 11 out of 13 patients with metastatic and/or recurrent head and neck cancer. Complete response (CR), partial response (PR) and minor response (MR) were noted in six, three and two cases respectively. OK-432 local administration therapy could create a new strategy for cancer therapy.

Infra-red tympanic thermometry is a relatively new technique for measuring body temperature which requires the minimum of co-operation and is quick and easy to use. It is therefore ideal for use in children. Its use is becoming more widespread and as it is theoretically possible that minor ear surgery may interfere with function its reliability in these patients may be in question.

Twenty-two children (mean age 5.3 years) who underwent myringotomy ± grommet insertion had the tympanic temperature of each ear measured immediately before, and 15 minutes after, surgery on the recovery ward. No difference was found between the pre- and post-operative temperatures (mean difference – 0.1°C, p>0.1, paired t-test, hypothesized difference of 0).

This thermometer appears to be a reliable way of monitoring body temperature on a paediatric ENT recovery ward in patients who have undergone minor ear surgery.

Marfan syndrome (MS) is a rare connective tissue disorder, uncommon in otological practice. Ear surgery in MS has not been previously reported. An identical complication of meatoplasty developed in two patients with MS after modified radical mastoidectomy and meatoplasty for chronic otitis media. Both cases presented postoperatively with an external auditory canal narrowing when the walls of the initial meatoplasty in both cases collapsed. It is proposed that this occurred because of the inherent structural abnormality of the cartilage in Marfan syndrome. A simple technique of revision meatoplasty is described that resulted in successful management of these cases.

Wegener's granulomatosis is a multi-system disease characterized by granuloma formation and a necrotizing vasculitis. It classically presents with involvement of the upper and lower respiratory and renal systems. However locoregional disease is common and may include otological manifestations. Facial nerve palsy has been reported during the course of the disease process but it is extremely rare for it to be the presenting feature. Previously reported cases have involved a protracted diagnostic process including exploratory tympanotomy, mastoidectomy and facial nerve decompression. We report a case of Wegener's granulomatosis which presented with a facial nerve palsy. An early diagnosis was achieved by measurement of the erythrocyte sedimentation rate (ESR), followed by serological assay of cytoplasmic anti-neutrophil cytoplasmic antibody (cANCA). Histological examination of nasal mucosal biopsies confirmed granuloma formation consistent with a diagnosis of Wegener's granulomatosis. This allowed early treatment with immunosuppressive therapy and avoided unnecessary and potentially hazardous middle ear surgery.

Vestibular nerve dysfunction as the major neuro-otological symptom in one of the osteopetrosis group of bone disorders is unusual. We describe a patient with Engelmann's disease who presented in this manner and who benefited from an eighth nerve decompression procedure. Surgical decompression of the internal auditory meatus to relieve vertigo has to our knowledge not been previously reported in this condition.

A case of left otalgia in a patient suffering from longstanding ulcerative colitis is reported. The patient was treated for an exacerbation of his disease with courses of mesalazine and sulphasalazine during which time he developed otalgia. The otalgia disappeared with cessation of the drugs. It is concluded that in the absence of any other head and neck cause that the otalgia was a complication of the drug therapy.

The nasal and the paranasal sinuses are a rare site for solitary fibrous tumours. There have been no previously reported cases in the English literature, with eight cases in the world literature (Witkin and Rosai, 1991; Zuckerberg et al., 1991). We present a case of a solitary fibrous tumour arising in the nasal cavity and review the previous reports.

Paranasal and rhinocerebral mucormycosis refers to uncommon opportunistic fungal infections, reported to occur especially in association with diabetic acidosis (the most common), immunosuppressive therapy, malignancy, or other chronic debilitating disorders. However, patients who have no underlying disease have occasionally been affected. According to the literature reviewed, only 13 well-documented cases without any predisposing factor have been previously reported. We describe a unique case of sphenoidal mucormycosis in an otherwise healthy individual, and the first patient to present with headache as the only symptom. We emphasize the importance of a high index of suspicion for early diagnosis and prompt management.

A case of a benign histiocytoma of the larynx in a 39-year-old man is presented. Laryngeal fibrous histiocytoma is extremely rare. Its pathology is described including arguments for benignity. The literature is reviewed and management is discussed.

A 51-year-old woman complained of hoarseness of two years duration. The patient's past medical history was significant for autoimmunological hepatitis and arthritis for which she had not received treatment. Laryngoscopy and laryngeal stroboscopy revealed ‘bamboo joint-like nodules’ on both true vocal folds. These nodules resembled rheumatoid nodules and were suggestive of a collagen disease. Previous reports have documented that the treatment for such conditions related to collagen diseases is surgical resection. However, we initially attempted to treat the laryngeal lesions systemically with prednisolone. The hoarseness and the bamboo-like nodules disappeared six months after the treatment. Furthermore, the liver function test returned to normal and arthritis completely resolved. Based on our patient's response to this treatment, we diagnosed atypical-SLE and a lupus laryngitis. This case suggests that studies of the larynx may be helpful in the early diagnosis of collagan diseases and that such conditions may respond to systemic treatment.

Giant polypoidal hamartomas of the pharynx and oesophagus are rare benign tumours of unknown origin, exceptionally arising from the oropharynx. We report the case of a 74-year-old man who developed sudden nausea and a foreign body sensation. Shortly afterwards he regurgitated a 25 × 3 × 1.5 cm pedunculated fleshy mass, still attached to the inside of his throat. The patient was anaesthetised, the mass traced to the right tonsillar fossa and adjacent oropharyngeal wall. The pedicle was clamped and the lesion excised. Histology was consistent with a giant oropharyngeal hamartoma. We discuss the pathogenesis and potential complications of this condition. The literature is reviewed.

An unusual case of an adult female with anorexia nervosa, who developed a retropharyngeal abscess, is presented. This case is reported both because of the paucity of reports on retropharyngeal abscess and because of the dramatic unusual aetiology.