Laryngeal paraganglioma originates in the neural crest cells in the laryngeal paraganglia. Two distinct types may be cited on the basis of clinical features, but biopsy is essential for diagnosis. By light microscopy, the Zellballen pattern appears pathognomonic. The treatment consists of surgical excision.

In this article, due to the rareness of the tumour, one case of laryngeal paraganglioma is presented. The general knowledge and the available literature are reviewed. The difficulties in the differential diagnosis are stressed and treatment principles are discussed.

A prospective randomized controlled study was carried out to investigate the effect of prophylactic antibiotic ear drops used for five days after bilateral grommet insertion. The average improvement in the hearing threshold was significantly better in ears in which there was an effusion (16 dB) compared with no effusion (9 dB). The drops had no significant effect upon grommet function at three months measured by blockage rates, extrusion rates or improvement in pure tone audiometry whether or not there was an effusion. The drops were not therefore cost-effective.

The per-operative instillation of ototopical antibiotic/steroid drops reduces the incidence of early otorrhoea after tympanostomy tube insertion. Whether this is due to the chemical properties of the antibiotic/steroid or simply the mechanical instillation of fluid is unclear. In this paired matched study of 161 subjects Gentisone HC was shown to significantly reduce the otorrhoea rate compared to normal saline (1.24 per cent compared with 9.32 per cent, p<0.005, difference 8.07 per cent, 95 per cent confidence interval for difference 3.21 per cent to 12.93 per cent). Capillary viscosimetry proved Gentisone HC to be more viscous than normal saline. The benefits are due to Gentisone HC's chemical properties, and Gentisone HC rather than normal saline instillation per-operatively is recommended when tympanostomy tubes are inserted.

The exact causative factor(s) of bone erosion in cholesteatoma are not known. In recent years, the possible role of cytokines has drawn attention. Since the studies on cytokines in cholesteatoma are limited and depend on histopathological methods, the present work approached this subject by biochemical determination of TNF-α lysosomal enzymes, acid phosphatase (total and tartrate resistant), cathepsin B, leucyl aminopeptidase lysozyme together with non-lysosomal enzymes calpain I and II in 50 cholesteatoma samples (epithelial and subepithelial tissues) in comparison with 14 normal skin samples from the external ear canal. The study revealed significantly increased levels of all previous indices in cholesteatoma epithelium and subepithelial tissues compared with healthy skin. The levels of these indices reflected the clinical severity of the disease as reflected by their significant increase in cases with erosion of two or three ossicles, erosion of dural plate, sinus plate and facial canal and more extensive cholesteatoma. It is likely that TNF-α acts both directly by causing bone erosion and indirectly by stimulating the release of lysosomal enzymes. The latter mechanism is supported by the significant correlations observed between TNF-α and lysosomal enzymes. The non-lysosomal enzymes calpain I and II seem to participate in the bone erosion associated with cholesteatoma by their involvement in collagen destruction. Due to the suggested role of TNF-α in bone destruction associated with cholesteatoma the use of anti-inflammatory drugs should be taken into consideration in otitis media to diminish bone destruction. Similarly, antibiotics should be used to prevent the deleterious effects of bacterial endotoxin.

Flexible nasendoscopy is now an integral part of the diagnostic process in Otorhinolaryngology. Topical local anaesthesia is generally recommended and cocaine is usually the drug of choice in view of its concurrent vasoconstrictor action. However, it is expensive, a controlled drug and serious side effects have been reported. Co-phenylcaine forte is a new preparation which also has both local anaesthetic and vasoconstrictor properties. This study compares the efficacy of cocaine and Co-phenylcaine in flexible nasendoscopy and concludes that they provide similar local anaesthesia and vasoconstriction of the nasal mucosa. Co-phenylcaine forte can therefore be used as an alternative to cocaine in flexible nasendoscopy.

Over the period of a year, Merocel nasal packs were used routinely as the primary form of packing in patients referred to the hospital with epistaxis that had not resolved with simple measures, and in whom packing was thought to be required. Their effectiveness was assessed. The packing was usually performed by inexperienced senior house officers. The Merocel packs successfully controlled bleeding in 91.5 per cent of the patients in whom they were used. Use of the correct insertion technique is very important but is very easy to learn and perform. The actual insertion takes only a couple of seconds. Discomfort during insertion, whilst in situ and on removal was assessed.

Merocel nasal packing is an effective form of first line treatment in patients with epistaxis.

Chronic sinusitis is one of the most common diseases treated in outpatient centres. In this prospective study, 49 patients with the diagnosis of chronic maxillary sinusitis were evaluated microbiologically by using sinus swab, irrigation fluid and sinus mucosal tissue specimens obtained during endoscopic sinus surgery. There was no bacterial growth in seven cases. In the remaining 42 cases a total of 89 bacteria were isolated, 28 of them being classical pathogens and 61 being non-classical pathogens. Among the classical pathogens Staphylococcus aureus was the most common one. The correlation between the isolates obtained from maxillary sinus and isolates obtained from throat, nose and nasopharynx did not have a predictive value. Since the overall rate of classical pathogen isolation from patients with chronic sinusitis was not significantly high, the possible role of factors other than bacterial growth should be identified in the pathogenesis of chronic sinusitis.

Botulinum toxin injection is an effective treatment for spasmodic dysphonia. There are ethical difficulties in performing a controlled placebo trial to assess the effectiveness of this treatment. This paper shows a significantly decreased clinical response following technically poor injections given to patients who respond well to good quality injections.

We have treated seven patients with a plunging ranula during the past 10 years. All patients underwent surgery via a cervical approach. In two, the ranula reached the anterior neck by passing through a dehiscence in the mylohyoid muscle, while in the other five the plunging ranula passed posteriorly to the mylohyoid muscle. A pseudocyst was extirpated in each patient. Although total sublingual gland excision was not performed in two patients, no recurrence was observed in any patient. Incision of the pseudocyst facilitated subsequent procedures and decreased the incidence of transient facial paralysis. In the presence of a cervical mass without swelling of the oral floor, a cervical approach may still be the method of choice either for the first operation or for salvage surgery after recurrence subsequent to intraoral procedures. It is based on the fact that there may be ectopic sublingual glands residing on the inferior surface of the mylohyoid muscle.

The process of clerking routine pre-operative admissions involves the house officer taking a full medical history and performing a full physical examination. The diagnostic yield is thought to be low, and the educational value to the house officer is also small. This study addresses the question as to whether routine physical examination is always indicated.

One hundred and nine children admitted for routine Otolaryngology procedures were prospectively studied to identify the importance of examination in the pre-operative assessment of patients.

The results showed that 51 per cent of the children admitted had risk factors. The medical history was sufficient to identify these risk factors in all patients with the exception of one cardiac condition.

This study concludes that a suitable alternative to the current process of clerking such as a standardized nurse history could be safely and efficiently undertaken. Eliminating the tiny percentage of previously unrecognized disease would be a prerequisite for such a change.

Foreign bodies in the noses of children may often be expelled by simple nose blowing. Success of this manoeuvre depends on how firmly the object is lodged, and on the co-operation and skill of the child. Attempts at direct removal using instruments frequently result in the patient becoming distressed and resort to general anaesthesia is sometimes required. This short communication describes a series of cases in which nebulized adrenaline helped loosen firmly impacted foreign bodies, thereby facilitating removal, minimizing upset for the child, and avoiding anaesthetic risk.

Collapse of the external auditory meatus during audiometry can lead to spuriously increased hearing thresholds being obtained, particularly at high frequencies, and may simulate conditions such as noise-induced hearing loss, presbyacusis and retrocochlear pathology. Consequently, inappropriate investigations and management may be undertaken. Two patients with elevated thresholds secondary to ear canal collapse are described. The implications of initially failing to identify the true nature of their ‘hearing losses’ are highlighted and strategies to avoid such pitfalls are discussed.

A Case Is reported of a 59-year-old Caucasian male with oculopharyngeal myopathy and sensorineural hearing loss. He presented with progressive ptosis, sensorineural hearing loss over several years and symptoms of mild dysphagia. Further enquiry into his family history revealed that every male member in his family that lived beyond the age of 60 exhibited identical symptoms. Symptoms of ptosis and dysphagia are consistent with the rare autosomal dominant condition of oculopharyngeal myopathy, believed to be due to mitochondrial disease. The combination of ptosis, dysphagia and sensorineural hearing loss with normal distant muscle group biopsy has not been described before.

This case study describes a therapeutic strategy using a cochlear implant for a bilateral acoustic neuroma deafened patient. The cochlear nerve had previously been sacrificed on one side during tumour removal, but on the remaining side a functioning cochlear nerve was assessed by electric promontory stimulation in spite of a neuroma extending into the vestibular labyrinth. The patient was successfully stimulated with a Nucleus 22- channel implant after removal of the intracanalicular portion of the neuroma via a middle fossa approach.

Myofibromatosis is an uncommon, usually cutaneous, condition in which there is a benign proliferation of myofibroblasts. Solitary and multicentric nodular forms with, and without, visceral involvement have been described. Infantile and adult sub-types have been reported, each having distinct clinicopathological features. Presentation in the head and neck is common. It is frequently misdiagnosed because of its peculiar histological features. The first documented cases of infantile and adult myofibromatosis involving the nasal cavity are reported.

We report a case of vasculitis causing facial swelling and exophthalmos which on clinical and histological grounds is thought to be limited Churg-Strauss syndrome. An excellent response was achieved to high doses of systemic steroids and cyclophosphamide.

Congenital upper airway obstruction presents a life-threatening situation when encountered in the delivery room. We present a case in which in utero diagnosis of this malformation was suspected, but unfortunately the neonate did not survive due to the inability to provide adequate ventilation. The prenatal sonographic features of this rare malformation are outlined, and the literature reviewed.

Lymphangiomas are uncommon benign congenital tumours. Most occur in the head and neck region and the vast majority present before the age of two. This paper describes the presentation and management of four cases presenting after puberty and involving the parotid gland. The cases are unusual in that all were intimately associated with the facial nerve and in an older population. The value of selective neck dissection and facial nerve exposure as an approach to these lesions is discussed.

An unusual case of an intra-parotid haematoma is presented. The history was misleading and the ultrasound and CT results apparently contradictory. The investigations are explained in the light of the natural process of haematoma evolution. It is recommended that all radiological investigations be correlated by a single radiologist, and suggested that repeated ultrasound scans, at appropriate time intervals, might be used to confirm the diagnosis and follow the process of clot resolution.

Solitary fibrous tumour was first described as a pleural tumour. It has been reported in a number of extrapleural sites including the head and neck. We present the first case of solitary fibrous tumour of the infratemporal fossa described in the English literature. Complete excision was achieved using the orbitozygomatic infratemporal craniotomy approach.