This investigation was carried out in the Audiology and Speech Pathology Section of the Department of Otorhinolaryngology of Hacettepe University. The pregnant group comprised of 20 women followed by the Department of Gynaecology and Obstetrics of the same university; 18 non-pregnant women comprised the control group. The aim of this investigation was to study the relationship between hormonal changes in pregnancy and cochlear functions. All subjects underwent ENT examination, audiologic and acoustic immitance measurements and auditory brain stem response (ABR) tests. Results from each trimester and post-partum period of the pregnant group were compared. These results demonstrated that there was a decrease in hearing levels for 125 Hz, beginning in the first trimester and increasing in the second and third trimesters. Hearing returned to normal in the post-partum period. Similar findings were also obtained for 250 and 500 Hz; however, frequencies higher than 500 Hz demonstrated no significant correlation. Uncomfortable loudness was statistically significant between the third trimester and post-partum period. ABR tests did not reveal any differences. In conclusion, there is a low-frequency hearing loss and tolerance problem in pregnancy mimicking cochlear pathology. However, this hearing loss did not reach pathologic levels in any case and returned to normal in the post-partum period.

The possible cochlear toxicity of systemically applied macrolides - erythromycin (ER), azithromycin (AZ) and clarithromycin(CL) - was investigated in guinea pigs by measuring transiently evoked otoacoustic emissions (TEOAEs). A single dose of 125 mg/kg intravenous (i.v.) ER caused no change in TEOAEs in guinea pigs (p>0.05), whereas AZ (45 mg/kg orally) and CL (75 mg/kg i.v.) reversibly reduced the emission response (p<0.05). The reversible reduction of TEOAE responses due to AZ and CL, which is in accordance with the clinical picture of AZ and CL ototoxicity, could likely be attributable to the transient dysfunction of outer hair cells. The present study reveals that at least one ototoxic effect of AZ and CL is on the inner ear. The results may also encourage planning clinical researches on TEOAE monitoring in patients receiving high doses of AZ or CL.

A cohort of 973 consecutive attendants at a rhinology clinic was studied prospectively and divided into patients without facial pain (n = 566, 58 per cent) and patients with facial pain (n = 407, 42 per cent). The prevalence of nasal mucosal contact points was the same in both groups, being four per cent in patients with nasal contact points without facial pain and four per cent in patients with facial pain. A contact point is defined as when contact remains after topical decongestion. Of the 18 patients with facial pain, nine had a spur contacting the lateral nasal wall and nine had a middle turbinate contacting the septum. These 18 patients were followed up for a mean of two years and two months. In the light of their treatment and response the following diagnoses were made: five had tension-type headache, six had midfacial segment pain, one had migraine, two had cluster headache and four had purulent nasal disease. Of the four with unilateral symptoms, two had a contact point on the contralateral side. Eleven of these 18 patients responded to medical treatment for tension-type headache or midfacial segment pain, migraine and cluster headache, three patients were better after surgery for coexistng purulent nasal disease and one patient had a spur removed surgically and remained better at 2 years follow-up, whereas three patients were no better after the same procedure. The results demonstrate that the prevalence of nasal contact points in patients with facial pain is the same as in those within pain. Surgery undertaken to remove mucosal contact points for facial pain is usually unnecessary as the aetiology of this facial pain appears to be a more central processes.

Otolaryngologists and general practitioners commonly prescribed intranasal corticosteroid drops for rhinitis. Compliance in real patients has not previously been studied, but is generally believed to be poor. Recent concerns over systemic adverse effects of topical corticosteroids have highlighted the risks of overdosing. Fifty patients, who were prescribed betamethasone, were prospectively studied for accuracy of compliance using a weighed dose study. Patients consistently administered inaccurate quantities of nasal corticosteroid drops, with a marked tendency to overdose up to four times the recommended daily dose (RDD) in some cases. The mean dose administered was 200 per cent of the RDD. Of the 50 patients, only seven (14 per cent) administered the correct dose. The introduction of metered-dose delivery systems should be considered to reduce the risk of inadvertent overdosing.

Diagnosis of allergic fungal sinusitis (AFS) in patients who present with rhinosinusitis and polyposis is based upon certain clinical, histopathological and mycological histopathological criteria are the demonstration of fungal hyphae in allergic mucin and absence of tissue invasion in the excised polyps. Previous reports have indicated difficulty in demonstrating fungal hyphae on histological examination in up to 75 per cent of cases. Analysis of a series of 25 patients with AFS, suggested methods to ensure demonstration of fungal hyphae and thus increase diagnostic yield in cases with suspected AFS. criteria. Specific diagnostic

The biological activity of acinic cell carcinoma is uncertain. Histological dedifferentiation is one possible reason for recurrent disease, and this study was undertaken to assess its importance in acinic cell carcinoma. The initial and recurrent specimens from five patients with acinic cell carcinoma were assessed histologically and using flow cytometry, AgNOR estimation and morphometric analysis for evidence of dedifferentiation. No objective evidence of a change in biological aggressiveness in recurrent acinic cell carcinoma was identified. In this limited series of a rare salivary gland tumour, it would appear that factors other than dedifferentiation, such as close/involved margins, histological type and stage have a more meaningful effect on the likelihood of recurrence and prognosis.

As a result of a previous audit on the management of sleep apnoea hypopnoea syndrome (SAHS) which showed long waiting times that were primarily due to unnecessary interspecialty referrals, a change in practice was adopted. All referrals are now sent a questionnaire about symptoms suggestive of SAHS, the Epworth Sleepiness Scale score and their body mass index (BMI) which when returned are categorized into having a high, intermediate or low risk of SAHS. Those patients with a high probability have home overnight oximetry and those with intermediate probability have video oximetry. Those with a low probability are referred directly to ENT. We audited the first 100 patients referred. All were General Practitioner referrals to either ENT or respiratory medicine. Only two patients had a low probability score and were seen directly in ENT. Following sleep study analysis, 10 patients were referred directly to ENT with no respiratory medicine follow-up and nine were discharged back to the General Practitioner with no apnoea or snoring. Eighty-one patients were followed up by respiratory medicine. Of these, 49 received a trial of nasal continuous positive airway pressure (nCPAP) and six were referred to ENT. Therefore the majority justified an investigation to exclude SAHS in the first instance and an unnecessary initial ENT appointment was avoided. We have reduced the average waiting times to sleep study by approximately 90 days and to nCPAP trial by 32 days, mostly due to decreased delays in interspecialty referrrals. We have also demonstrated a greater than 50 per cent reduction in ENT clinic visits, a small increase in the number of sleep studies but no increase in respiratory clinic workload.

We present ‘Mishra's rhinoscope’, a novel, cost-effective technique of zero-degree rigid nasoendoscopy with a modified otoscope, the results of which are comparable with the fibreoptic sinoscope. This is particularly suited for the developing world where financial constraints restrict the diagnosis of an occult nasal pathology.

Topical vasoconstriction using four to 10 per cent cocaine is widely used for nasal surgery. A number of techniques are being used with equally satisfactory results. Here we describe a novel method of topical application of cocaine for nasal surgery. The method is simple, cheap and effective.

Mite infestation of the ear is an unusual clinical problem that is easily cured with simple measures and recurrent infestation has not been reported till date. We present here a patient who developed recurrent infestation of otherwise healthy mastoid cavities with the storage mite Caloglyphus berlesei, secondary to occupational exposure. This kind of recurrent mite infestation of the ear has not been described before.

A rare case of ossifying fibroma of the temporal bone is presented. Fibro-osseous lesions are benign neoplasms but may show an aggressive behaviour when invading important anatomical structures. The lack of experience in the treatment of those tumours is reflected in the small relative literature. The purpose of this paper is to contribute to the few cases already reported.

Adult nasal dermoid cysts and sinuses are rare. Here we describe the surgical management of a 37-year-old patient with a longstanding nasal dermoid cyst and discharging sinus. A combination of an open rhinoplasty approach with a small dorsal incision was used to excise the lesion followed by primary reconstruction with septal cartilage.

Tuberculosis, with its varied presentations and numerous complications, is a relatively common disease in developing countries like India. Amongst its many presentations, pulmonary tuberculosis is the commonest. A tubercular laryngeal abscess is an extremely rare entity. We report a 37-year-old male, diagnosed with a tubercular laryngeal abscess which was successfully treated under local anaesthesia by incision and drainage and in whom a tracheostomy could be avoided.

Bilateral extracranial internal carotid aneurysms are very rare, though well documented. We report a case of bilateral extracranial internal carotid aneurysms presenting with vocal fold paralysis, which we believe to be the first.

We present a case of a 38-year-old man who was referred to us with a right-sided quinsy. However he was found to have a large lympho-epithelial cyst in his right parapharynx mimicking the signs of a quinsy to the unsuspecting eye. We describe this case to illustrate an unusual cause of a swelling of the lateral pharyngeal wall.

Endoscopic stapling of pharyngeal pouches is gaining popularity and is said to be a quick procedure with minimal morbidity and mortality. So far, there have been few reported cases of any severe complications following this procedure. However, complications as with other treatment modalities can occur. A case of mediastinitis due to delayed oesophageal perforation following the stapling procedure is presented.

Post-operative neck complaints are not an uncommon finding following adenotonsillectomy. However, non-traumatic subluxation of the atlantoaxial joint (Grisel's syndrome) should be considered in cases of persistent neck pain and stiffness. An early diagnosis and adequate treatment of this rare condition is mandatory to prevent potentially serious complications. We describe three cases with persistent torticollis in the post-operative period, discuss the pathogenesis and evaluate the clinical management of these patients.

Primary cutaneous adenoid cystic carcinoma (PCACC) is a particularly rare variant of sweat gland carcinoma with characteristics of indolent and progressive course and high incidence of perineural invasion and local recurrence. However, regional lymph node metastasis in PCACC is exceedingly rare and its prognostic implication is unknown. Only two previous cases of recurrent scalp PCACC were reported to be associated with cervical lymph node metastases at 42 months and 20 years, respectively, after the initial treatment. We present a case of PCACC occurring in the left parotid region with regional neck lymph node metastasis in a 64-year-old man. Because the occurrence of lymph node metastasis seems to be associated with recurrent PCACC, we suggest that neck dissection may be included in the treatment for recurrent PCACC patients.

Maxillary sinus hypoplasia (MSH) is occasionally encountered in otorhinolaryngological practice. The hypoplastic sinus is liable to mucus retention, and cases of MSH usually present as a persistent maxillary sinusitis. Endoscopic surgery has been recommended as an effective treatment for the sinus infection. However, MSH is associated with anomalies of the lateral nasal wall which, if not recognized pre-operatively, can lead to inadvertent surgical damage to the orbit. Although some of these abnormalities can be evident endoscopically, the role of imaging in diagnosis and identification of important surgical landmarks is paramount. A posteriorly placed middle meatal antrostomy is recommended as the surgical treatment of choice.