The mastoid air cell system is an important contributor to the pathophysiology of middle-ear inflammatory disease. The mastoid cavity is not only an air reservoir, but also an active space for gas exchange. Various methods of temporal bone imaging have been designed to investigate mastoid pneumatization. In this study, we examined 100 normal temporal bones for the evaluation of mastoid pneumatization. Mastoid air cell systems were measured by reconstructed axial and coronal high resolution computed tomography (HRCT) images. The reconstructions were made by a three-dimensional multiplanar volume rendering (3D MPVR) technique. The mean volume of the mastoid air cell pneumatization was 7.9 cm3 (4.0-14.0 cm3, SD = 2.3 cm3). The ears were allocated to the groups with respect to measured mastoid air cell pneumatization. Twenty-eight per cent of the ears have small pneumatization with an aircell system not exceeding 6 cm3. Fifty-two per cent had an air cell system between six and 10 cm3, and 20 per cent had an air cell system exceeding 10 cm3. With its excellent imaging quality and the ability to eliminate bone and soft tissue, HRCT is the best method for evaluating the mastoid air cell system. The 3D MPVR technique must be used tomeasure the temporal bone/mastoid pneumatization for the best results.

There is little information in the current literature about the management of dizziness in Primary Care (General Practice). An attempt was made to evaluate this by carrying out a postal survey of General Practitioners’ (GPs) treatment methods in four Health Authorities in England and Wales. The survey revealed that eight out of every 1000 individuals are likely to consult their GP on account of dizziness in a 12-month period. The symptom is mostcommon in the 60–80 years’ age group, with ’labyrinthitis’ being the commonest diagnosis. In the majority of cases (74.9 per cent) there was an improvement in the symptoms and only 13 per cent were referred to a specialist clinic. The survey also highlighted the need for additional resources to improve the management of these patients.

The differences in facial anatomical structures of the major ethnic groups,may also be reflected in nasal resistance. Active anterior rhinomanometry (AAR) is the recommended technique for the objective assessment of nasal airway resistance (NAR). This study comprised of 85 adult Malay subjects. All the subjects had to undergo a primary assessment of relevantsymptoms of nasal disease and nasal examination before undergoing AAR assessment. The mean value of total nasal airway resistance (NAR) was 0.19 Pa/cm3/s (ranged from 0.09 to 0.55Pa/cm3/s) at 75 Pa pressure point and 0.24 Pa/cm3/s ranged from 0.12 to 0.52 Pa/cm3/s) at 150 Pa pressure point. The mean unilateral NARwas 0.46 Pa/cm3/s at a reference pressure of 75 Pa and 0.51 Pa/cm3/s at a reference pressure of 150 Pa. In this study we presented normal values for NAR in healthy Malay adult subjects. AARproves to be a valuable clinical method for recording and quantitating nasal resistance.

Nasal obstruction is a subjective complaint in patients with nasal disease.The ability to quantitate the nasal ventilation dysfunction would be useful for making the appropriate choice of nasal disease management. This cross-sectional study comprised of 200 adult subjects. They underwent assessment of relevant symptoms, nasal examination and investigations before undergoing active anterior rhinomanometry (AAR) assessment. A group of 88 normal subjectsand 112 patients with nasal disease were included. The mean total nasal air resistance (NAR) was significantly higher in patients with nasal disease (0.33 Pa/cm3/s) as compared tonormal subjects (0.24 Pa/cm3/s). There was no significant difference in total NAR between patients with symptoms of nasal obstruction and those without the symptoms (p = 0.42). It is concluded that AAR is a sensitive but not a specific tool for the detection of abnormalities in NAR and it failed to relate to the symptom of nasal obstruction.

A double-blind randomized prospective case-control pilot study was performed to assess tissue distortion caused by the infiltration of local anaesthetic to the dorsum of the nose and to see if this was altered by the addition of hyaluronidase. Forty patients undergoing nasal manipulation for fractured nasal bones were randomized to receive either 4 ml of twoper cent lignocaine and adrenaline 1:200000 or 4 ml of two per cent lignocaine and adrenaline 1:200000 with 1500 IU hyaluronidase, which was infiltrated subcutaneously over the nasal dorsum.One surgeon using a standardized technique performed the nasal infiltration. Other outcome measures were ease of manipulation, adequacy of the reduction, patient satisfaction with cosmesisand patient analgesia requirements. There were trends for decreased tissue distortion and improved ease of manipulation in the hyaluronidase group. Larger trials are required to confirm these results.

The aim of this study was to determine the incidence of bacteraemia during tonsillectomy and investigate the effect of the timing of culture sampling on the incidence of bacteraemia associated with it. Sixty-four consecutive patients who had been admitted for elective tonsillectomy were included in the study. Patients were randomly classified into two groups. Blood cultures as well as tonsillar surface and deep tissue cultures were obtained from all patients before tonsillectomy and 60 minutes after tonsillectomy. In addition, blood cultures were taken within two minutes following tonsillectomy for group 1 and 15 minutes after tonsillectomy for group 2. In group 1, the cultures obtained within two minutes were positive in nine patients, while only two of the blood cultures taken post-operatively were positive in group 2. The difference between the two groups was statistically significant (p < 0.05). The results of this study suggest that a transient bacteraemia occurs frequently in association withtonsillectomy, but the timing of culture sampling for its detection is important.

Surgery for benign parotid gland salivary neoplasms is associated with sequelae: scar and divot defect and complications, facial nerve paresis/paralysis and Frey’s syndrome. These potential sequelae and complications are discussed with all patients prior to operation. We contacted 212 patients who had undergone surgery for benign parotid disease during1988–1997, by postal questionnaire. We enquired about their perception and recollection of the information they had received pre-operatively and to document and comment upon what problems they had experienced in the early and late post-operative period. The usable return rate was 75.5 per cent (173/212). Most patients (90 per cent) were satisfied with the information theyhad received pre-operatively. The complication and/or sequelae rates for facial nerve palsy (temporary 26.3 per cent, permanent 1.9 per cent), Frey’s syndrome (12.5 per cent) and sensory deficit about the cheek and ear (30.6 per cent), are comparable to other published studies.

This was a prospective study and analysis of the clinical nature and severity of consultation, patient age and sex, place of consultation, grade of attending doctor and management strategy of in-patients referred for a specialist opinion to a Department of Otolaryngology.

Internal requests for consultation were evaluated at the North Manchester General Hospital between October 1999 and August 2000 (n=101).

Patients referred to the Otolaryngology department were of a varied clinical nature with head and neck complaints being the largest group. Forty-six of the patients had minor complaints.Patients were found to be predominantly male and older than 50 years of age. The grade of attending doctor was predominantly a Specialist Registrar and the management strategy was most frequently conservative.

Many of the requests for consultation were regarding minor problems that could be referred to a routine out-patient clinic. There is a need to improve the indication criteria for internalconsultation, as well as the information provided in them.

The Groningen voice prosthesis can be successfully replaced using the back-loading system. We have attempted to minimize patient stress by developing a front-loading system that does not require insertion of the introducer via the tracheo-oesophageal shunt to the oral cavity or the mesopharyngeal anaesthetization regularly used with the back-loading system. Using our front-loading system, the existing prosthesis is removed, then the posterior portion of the replacement Groningen prosthesis is grasped by a pair of nasal forceps with a small jaw to make an acute angle and inserted into the oesophageal cavity through the shunt at a stroke. All 20 patients who underwent forward-loading replacement of a Groningen (n=17) or Blom-Singer (n=3) valve with a Groningen valve tolerated the procedure well and experienced no complications except, in some cases, for minor bleeding just after insertion of the prosthesis.The procedure was completed within 30 seconds.

In this retrospective study, the computed tomography (CT) archives of paranasal sinus examinations were reviewed and three cases of antroliths are presented. The archivesof paranasal sinus CT studies of 1957 patients (1023 females, 934 males, mean age 36.5 years) were surveyed. CT studies were performed using 3 mm collimation and interval in the coronal, axial or both coronal and axial planes.

Three out of 1957 patients demonstrated antroliths, all in the left maxillary sinus. Associated sinusitis was detected in all three patients. Only one patient was operated. The chemical analysis of the antrolith revealed it to be a calcium oxalate stone. All the relevant literatureis reviewed and only 25 other cases of true antrolithiasis were encountered. The clinical and radiological features of antroliths,as well as differential diagnosis were discussed.

Antrolithiasis should be considered in any case of sinusitis, that does not respond to appropriate medical therapy.

Paragangliomas are rare benign neoplasms arising from the neural crest-derived paraganglia of the autonomic nervous system. In the larynx three different localizations of paraganglia are known. Most laryngeal paragangliomas arise from the supraglottic paraganglia. A review of the literature shows that the treatment of choice for laryngeal paragangliomas is surgical excision. Since the implementation of CO2 laser surgery into laryngology in 1972, no reports of endoscopic laser surgical excisions of laryngeal paragangliomas have been published so far. We present the case of a 66-year-old female patient who suffered from a large (4 × 4 × 3 cm) left supraglottic paraganglioma. The tumour was completely excised utilizing the CO2 laser. Histopathology and immunohistochemistry of the tissue presented the typical findings of a laryngeal paraganglioma. The pre- and post-operative management as well as the treatment strategies are discussed. To our knowledge the present case demonstrates for the first time a complete transoral CO2 laser surgical resection of an advanced laryngeal paraganglioma.

Four consecutive female patients (age: 14–47 years) with laryngeal amyloidosis, treated with endoscopic CO2-laser surgery, entered the study. All patients underwent periodic microlaryngoscopies following surgery to confirm the adequacy of the surgical resection. Recurrences or suspected lesions were resected and fibrin deposits were removed to prevent the formation of synechiae or healing adhesions. After two negative microlaryngoscopies, performed two months apart, the patients were followed-up approximately every six months over a period from six months to 18 years, with no evidence of recurrences. The endoscopic CO2-laser technique is highly effective in the treatment of localized laryngeal amyloidosis.

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.

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.

Major late complications, following radiotherapy of head and neck carcinomas, such as laryngeal oedema, perichondritis and chondronecrosis usually occur between three and 12 months after treatment. However, the present case displayed necrosis of the laryngo-tracheal cartilage and ulceration of anterior neck skin with a tracheal fistula 44 years after irradiation. The reasons for the long interval between irradiation and late complications may be explained by long-standing hypovascularity and/or infection of the irradiated area. Histological study revealed chondronecrosis without inflammatory cells in the laryngo-tracheal cartilage and bacterial colonization of subcutaneous tissue. Necrotic tissue was removed and tracheostomy was performed. The fistula was almost completely closed using a delto-pectoral cutaneous flap and the clinical course of patient has been good. This paper demonstrates the possibility of laryngo-tracheal necrosis in cases that had received radiation as long ago as 44 years.

A glomus vagale is a rare lesion of paraganglionic cells in the vagal perineurium. Secretion of hormones by such a tumour is exceedingly uncommon, although associated metabolic processes have been demonstrated. Clinical effects of secretion reported previously have been minimal. We report a case where resistant hypertension was eventually found to be due to a secretory glomus vagale, and was greatly alleviated by removal of the lesion.

A case of chronic inflammation complicated by Candida infection of the parotid gland in a 50-year-old woman is presented. This eventually proved to be caused by Stensen’s duct obstruction due to an unusual radiolucent foreign body. The process that led to the proper diagnosis is presented and the importance of surgical exploration of the main duct in cases suggesting distal duct obstruction is stressed.

We present a case of a papillary tumour of the petrous bone. The established terminology for this rare neoplasm is endolymphatic sac tumour (ELST) but the true origin remains controversial. ELSTs are associated with von Hippel-Lindau disease. They are locally invasive, highly vascular and often require endovascular embolization prior to surgery. Both radiologically and histologically ELSTs are easily mistaken for other more common tumours such as paragangliomas and renal or papillary thyroid carcinoma metastases. This is important because local excision is curative.