A prospective study was performed to investigate the effect of neurosurgery on hearing. Thirty-two patients underwent neurosurgery while 32 patients who had surgical procedures not involving puncture or drainage of the subdural space, served as a control group. In the neurosurgical group, a significant loss of hearing was observed in the immediate post-operative period, with recovery over one week. No average threshold shift was observed in the control group. It is suggested that following neurosurgery the mechanism of hearing loss results directly from a decrease in pressure and/or volume of the cerebrospinal fluid, which is reflected within the perilymphatic fluid, comparable to a transitory endolymphatic hydrops.

Laryngeal papillomata can undergo spontaneous malignant transformation without being detected histologically and, in some instances, the disease may become so advanced, before the diagnosis is confirmed, that it is beyond any form of curative treatment.

Because of this limitation imposed by histopathological investigation, a study was undertaken in 17 adults with benign laryngeal papillomata, (three of whom underwent malignant transformation) to determine whether malignant transformation can be predicted from the clinical behaviour of the tumour. The following features were analysed: age, sex, patient's symptoms, frequency of excision of the papillomata, site of lesion, presence or absence of laryngeal oedema, the need for tracheostomy, vocal fold mobility and presence or absence of cervical lymph nodes.

It was found that decreased vocal fold mobility, the presence of cervical lymph nodes, exuberant and rapid growth requiring very frequent excisions, oedema of the larynx with airway obstruction requiring a tracheostomy are clinical features suggestive of malignant transformation.

Twenty-nine patients undergoing uvulopalatopharyngoplasty (UPPP) for snoring are presented. Ninety per cent expressed an overall improvement in their symptoms: 21 per cent had complete abolition of snoring. Postoperative complications included nasal regurgitation of food/fluids and hyponasal speech development.

Four theories have been suggested to explain the aetiology of lateral cervical cysts. Ascherson (1832) suggested that the cysts arose due to incomplete obliteration of branchial cleft mucosa, which remained dormant until stimulated to grow later in life. His (1886) suggested these cysts were vestiges of the precervical sinus. Wenglowski (1912) believed lateral cervical cysts developed from the third pharyngeal pouch (thymopharyngeal duct).

A number of investigators during the 19th century noted the close relationship between lateral cervical cysts and lymphoid tissue (Lucke, 1861). Luschka (1848) suggested that cystic degeneration of cervical lymph nodes was the mechanism by which lateral cervical cysts were formed. This theory received little support until King (1949) studied the histology of a large number of lateral cervical cysts and concluded that these cysts resulted from cystic transformation of cervical lymph nodes.

The evidence for and against these theories of aetiology is discussed. The debate is centred on a study of 20 patients with lateral cervical cysts operated on in the Department of Otolaryngology, Bedford Hospital, between January 1986 and December 1991. In all twenty cases the wall of the cyst was found to be composed of lymphoid tissue, histologically identical to that present in lymph nodes. The mean age of presentation was 31 years, and in no case was a tract or cord found which connected the cyst to the skin or pharynx.

The evidence strongly suggests that lateral cervical cysts develop from the cystic transformation of cervical lymph nodes. Mechanisms by which this may occur are discussed.

Serum leucine aminopeptidase (LAP) activity was assayed in patients with head and neck cancer. The levels were found to be significantly higher than the controls. However, the rise in serum LAP was nearly the same in all the patients studied, irrespective of the character or histopathology of the lesion but varied with respect to the site involved, i.e. from about 40 per cent in cancer of the hypopharynx to more than 100 per cent in cancer of the nasopharynx. Serum LAP activity was found to increase with the extent of the lymph node spread. After treatment the levels were found to be reduced.

Twenty patients with radiation-induced xerostomia were entered into a prospective randomized crossover study comparing a mucin-based artificial saliva (Saliva Orthana) and a mouthwash containing pilocarpine 5 mg three times a day. Overall the patients found that the pilocarpine mouthwash was more effective than the artificial saliva in relieving their symptoms (p = 0.04), and 47 per cent of the patients wanted to continue with this treatment after the study had finished.

Provox™ voice prostheses are low-resistance speech valves available since 1990 for post-laryngectomy voice rehabilitation. Candida spp. mycelial growth has always been a major problem in all prosthetic valves causing leakage and limiting valve life. We found that the Provox™ new valves were not exempt from the old problem. We performed a preliminary clinical, mycological and scanning electron microscopic assessment of Candida spp. growth on these valves. In contrast to studies done with other valves we found that the Candida mycelium on these new valves was a surface colony rather than growing into the valve substance, thus it might be feasible to control the mycelial growth by either mechanical cleansing or by using topical anti-fungal agents.

We present a nine-month-old baby, diagnosed as having Pallister-Killian syndrome, whose referral and investigation for possible hearing loss has led to this diagnosis. Emphasis is placed on the importance of the skin biopsy for the diagnosis of this underlying genetic abnormality.

Deafness is known to be associated with certain autoimmune disorders. This article describes a hitherto unreported possible association between pyoderma gangrenosum and progressive bilateral sensorineural deafness.

We examined a very unusual patient who developed peripheral facial palsy with chickenpox. A survey of the English literature revealed that eight such patients had been reported, but the period between the appearance of the vesicles of varicella and the facial nerve palsy ranged from five days before to 16 days after the eruption development. We presume that the route of infection was neurogenous in patients who had palsy after the appearance of the eruptions, but haematogenous in patients who had palsy before the appearance of vesicles. The two patients whose infection route was presumed to be haematogenous, had a poor prognosis.

Myxomas of the paranasal sinuses are rare but well described in the literature. They may be related to dental malformations or missing teeth, but may also occur without any such abnormalities. Their local aggressiveness and ability to erode bone should not be underestimated, and they should be totally removed whenever possible. A case of myxoma of the sinuses is described, in which recurrence followed several local removals. The patient was only cured by radical maxillectomy. The operation is described, and the literature on the subject reviewed.

Sarcoidosis is a multisystem granulomatous disease of unknown aetiology. Nasal sarcoidosis commonly affects the mucosa of the septum and the inferior turbinates. These patients may present with nasal discharge, crusting, obstruction, epistaxis or anosmia. We present an unusual case of nasal sarcoidosis involving the ethmoid sinus causing recurrent eyelid swelling and discuss its management.

A patient with a slowly progressive mitochondrial myopathy is presented. Mitochondrial myopathies are a diverse group of disorders both clinically and at the cellular level. In common with other neuromuscular disorders, bulbar symptoms may occur. However, though pharyngeal symptoms have been documented in all forms of the disorder, no previous account has described problems at the laryngeal level. We discuss the clinical findings and comment on the therapeutic options.

The case of a 73-year-old lady with late congenital pharyngo-laryngeal syphilis is presented. Its finding was at a potentially difficult intubation during the induction of general anaesthesia. She was asymptomatic; there was no evidence of active disease on either clinical examination or serology and no treatment was required. However, it is important to differentiate this condition from others which may require treatment.

Myxomas are rare tumours which may occur in the head and neck region. About 60 cases have been reported in the literature so far. We describe a retropharyngeal myxoma in this paper.

Lipomas in the head and neck region usually occur in the immediate subcutaneous tissue, and only rarely in the upper aerodigestive tract. We report here a case of a 58-year-old female with a lipoma in the peri-tonsillar space. The tumour originated from the left peri-tonsillar space over the palate tonsil and partly protruded into the oral cavity. MRI (magnetic resonance imaging) showed not only the acccurate location of the tumour but also suggested its pathology. To our knowledge, a lipoma in the peri-tonsillar space is quite rare and MRI is useful in its diagnosis.

Angioedema secondary to angiotensin-converting enzyme (ACE) inhibitors is rare, but it is a side effect which is likely to be seen more frequently because of the increased use of these drugs to treat cardiac failure and hypertension. Presentation is variable and the diagnosis may go unrecognized for many months or years. The cases reported illustrate problems both in the diagnosis and management of this life-threatening condition.

Removal of a parotid duct calculus using a Dormia basket is described and the literature reviewed. To our knowledge, this procedure has not previously been reported.

Nine cases of tuberculous otitis media were treated by us over the past 10 years. Six patients presenting with large tympanic membrane perforations were treated for suppurative otitis media at various ENT clinics. The remaining three patients presented without perforation. Intractable otorrhoea, aggravation of hearing loss, dizziness, and in one case facial palsy, resulted in eventual referral to us. Histological examination revealed a tuberculous granulation, confirming the diagnosis in most cases. CT in four cases with profound sensorineural hearing loss showed bone destruction of the otic capsule around the oval window and the promontory. Changes noted included a notch in one case, disappearance of the bony contour around the hook in two cases, and a distinct fistula in the final case. A cochlear fistula seemed to be characteristic of advanced tuberculous otitis media.

Eccrine cylindroma is a benign tumour arising from sweat glands in the skin. It favours the face, forehead and scalp involving the turban area and hence is called a turban tumour. Amongst a variety of tumours originating from adnexal skin structures, which may appear in the ear canal, eccrine cylindroma forms a very rare entity. We present such a case and discuss its pathological and clinical features.