In the summer of 2000, a team of medical and affiliated workers visited the South Sinai Desert to assess the medical problems and needs of the Bedouin population. This paper reports on the ENT diseases of this population, and discusses their healthcare needs.

Little has been published about the difficulties encountered during the insertion of osseointegrated implants for the attachment of bone anchored hearing aids (BAHA) and auricular prostheses in children. This study examines this issue in the first 51 children implanted at our centre. During surgery, the most common problem encountered was the presence of thin bone resulting in incomplete insertion of fixtures. Five fixtures had failed to integrate and six fixtures were lost in the long-term, however, only five children required revision surgery. The reason why few patients require revision was due to the judicious insertion of ‘sleeper’ fixtures. At follow-up, seven children required counselling for psychological problems. It is apparent from this study that osseointegrated implants in children are associated with difficulties, re-emphasizing that a paediatric osseointegration programme requires significant investment, and should only be undertaken by institutions that are committed to its success.

Congenital conductive hearing loss due to ossicular deformities can be treated by either rehabilitation with a hearing aid or surgical reconstruction. We present the results of exploratory tympanotomy performed in a large paediatric otolaryngology centre in 67 patients with non-serous congenital conductive hearing loss. Forty-two children had malformation of one or more ossicles without fixation of the stapes, and 19 had fixed stapes.

In 26 cases, the surgeon decided not to perform surgical correction. Seven operated patients were lost to follow-up. As a group, 47 per cent of the patients who underwent reconstruction showed no significant benefit from surgery, with post-operative air-bone gaps (ABG) greater than 30 dB. Assessment of the results by pathology showed that 64 per cent of the patients with mobile stapes had an air-bone gap within 30 dB compared to only 33 per cent of the patients with fixed stapes. One patient sustained severe sensorineural loss after the procedure. Considering that exploratory tympanotomy is a relatively minimal, benign procedure but that findings during exploration may exclude the option of reconstruction (in 39 per cent of our patients), we suggest exploring the ear, but in a more realistic, informed way.

Both hydroxyapatite (Ha) and titanium (Ti) are well-accepted alloplastic materials for ossicular prostheses. Many different designs of Ha and Ti prostheses are presently available. Fourteen surgeons of different seniority and surgical experience were asked to ‘test-drive’ four different types of ossicular prostheses in cadaveric temporal bones to investigate the user-friendliness of these protheses. The Goldenberg design Ha incus prosthesis and the Dusseldorf design Bell Ti prosthesis were used as partial ossicular replacement prostheses (PORP). The Richards design Ha incus-stapes prosthesis and the Dusseldorf design Aerial Ti prosthesis were used as a total ossicular replacement prostheses (TORP). Nine out of 14 surgeons found the Ha PORP to be more user-friendly because of the notch design in the head. The Ti prosthesis was found to be more difficult to manipulate because it was too light. Half of the surgeons preferred the Ti TORP because of the open design of the top-plate. The Ha TORP was thought to be too top-heavy and to have a tendency to fall over.

Ear damage in systemic lupus erythematosus (SLE) patients has been occasionally reported but the frequency and the mechanisms of ear involvement are not well documented. In an attempt to investigate the presence of hearing loss and the possible causes for it we prospectively evaluated 43 SLE patients. All patients underwent a complete ear-nose-throat physical examination and audiological evaluation with pure tone, impedance and speech audiometry. In addition, systemic manifestations of the disease and drug therapy were recorded. Finally, all patients were tested for the presence of autoantibodies. The results were compared with those of 50 age-matched healthy subjects.

Hearing loss (HL) was found in nine patients (22.5 per cent). More specifically, eight patients presented sensorineural hearing loss (SNHL) (21.5 per cent) and only one had conductive hearing loss (CHL) (2.63 per cent). From the patients with SNHL, one had bilateral symmetrical damage, four had bilateral but no symmetrical damage and three patients showed unilateral SNHL. Finally, the patient with CHL had unilateral involvement. There were no statistically significant differences between patients with HL and those without regarding age, disease duration, clinical disease manifestations, autoantibody profile and drug therapy.

In conclusion, one fourth of our SLE patients presented HL, expressed as SNHL affecting mainly the middle and high frequencies, while only one patient had CHL. This is a lower percentage of ear involvement in SLE than that reported by other investigators. The mechanism of ear damage remains unknown. Thus, additional prospective studies are needed to elucidate its pathogenesis.

Endoscopic sinus surgery (ESS) has undergone exponential growth worldwide in the last decade. It is now accepted as a safe and effective means of treating sinonasal disease. The purpose of this study was to determine whether post-operative debridement is necessary after ESS. Seventeen patients undergoing bilateral primary ESS were randomized to receive debridement of either the left or right ethmoid cavity. All patients included in the study had symmetrical disease. Saline douches and all other concomitant treatments were delivered bilaterally. Outcome measures were based on regular symptom scores and surgeons’ semi-quantitative assessment of the debrided and non-debrided cavities, over a three-month period. Analysis of adhesion rates, healing and symptom scores showed no statistically significant difference between the two groups. In conclusion, this study did not demonstrate significant benefit from post-operative ESS cavity debridement, at least with regard to cavity healing. This should be considered a pilot study and therefore limited conclusions can be drawn. Further work is needed to determine the optimum post-operative care for ESS.

The goal of the present work was to investigate possible risk factors for the poor response of some cases of chronic sinusitis to endoscopic sinus surgery in spite of the precision of the surgical technique. Eleven adult patients who were scheduled for revision endoscopic sinus surgery underwent a complete allergy workup. At the time of surgery, a tiny biopsy was taken from the maxillary sinus mucosa close to the middle turbinate. The specimens were processed for histochemical and transmission electron microscopic examination.

Six patients (55 per cent) proved to be allergic. Their sinus mucosa showed eosinophilic infiltration (6.1 cells/mm2), and mast cell degranulation. This proves that allergens can reach the sinus mucosa and have a direct impact on it. Another three patients (27 per cent) were non-allergic but exhibited mucosal eosinophilia (5.0 cells/mm2), and two of them showed mast cell degranulation. These patients were diagnosed as having nonallergic rhinosinusitis with eosinophilia (NARSE). The nasal mucosa of the remaining two patients did not reveal any characteristic pathological findings, and no pathologic diagnosis could be established for them. None of the patients showed electron microscopic evidence of purulent inflammatory changes, and the bacterial cultures recovered normal respiratory flora in nine patients (82 per cent).

The present research spotlights the importance of allergy and nonallergic eosinophilic infiltration of the mucosa as possible risk factors that may degrade the results of endoscopic sinus procedures and discusses some pertinent pathological and clinical aspects.

The aim of this study was to retrospectively survey patients who had undergone radiofrequency ablation of the soft palate for snoring complaints. Fifty-nine patients who had undergone radiofrequency ablation were sent an anonymous questionnaire to assess snoring (using visual analogue scales), pain and satisfaction with the procedure. Sixty-one per cent of the group returned the questionnaire. The mean time since operation was 17.5 months. Taking an improvement in snoring of 50 per cent or greater as a successful operation, snoring improvement occurred in 22 per cent. Post-operative pain was minimal with a median pain score of zero. Information was requested on whether the patient would undergo this procedure again, 50 per cent responded that they would and 44 per cent would advise a friend in the same situation to have this procedure.

Radiofrequency ablation of the soft palate, as in other forms of surgery for snoring, seems to have a relapse rate over the long-term.

Laryngeal manifestations of malignant sialogenic neoplasias are rare. This paper documents the clinical features, treatment, biological behaviour and prognosis of 15 cases of malignant sialogenic tumours of the larynx that were reviewed in a retrospective clinical and histopathological study. The 15 cases of malignant sialogenic tumours of the larynx were diagnosed at the University Hospital, Eppendorf, over a period of 33 years (1965–1998). Forty per cent were adenoid cystic carcinomas, 33 per cent mucoepidermoid carcinomas and 27 per cent were poorly differentiated adenocarcinomas. Local tumour resection, if necessary in combination with bilateral neck dissection and post-operative radiotherapy, was associated with a five-year survival rate in 80 per cent of the mucoepidermoid carcinoma cases. Adenoid cystic carcinoma was associated with a less favourable five-year survival rate of 33 per cent. Low-differentiated adenocarcinomas were associated with the least favourable prognosis with a five-year survival rate (25 per cent). The prognosis for these tumours is thus poorer than for squamous cell carcinomas with the same localization and TNM status.

We report the use of nebulised adrenaline in the treatment of secondary oropharyngeal haemorrhage. Cases involving two adults and one child are presented to illustrate the usefulness of this technique in helping to achieve haemostasis without the need for a general anaesthetic. The mechanisms of the haemostatic action of adrenaline are also explored. We believe that in selected cases nebulised adrenaline is both safe, effective and easily tolerated and represents a useful additional tool in the treatment of oropharyngeal haemorrhage.

The association of Kallmann’s syndrome with conductive hearing loss has not previously been described. We report the findings at tympanotomy in three ears of patients with Kallmann’s syndrome and conductive deafness. The literature related to this topic is reviewed, and the treatment of these patients is discussed.

Adult presentation of the Dandy-Walker syndrome is extremely rare. We report a case where the patient was first diagnosed at 75 years of age because of sudden onset of unilateral senorineural deafness and episodic vertigo. He remained well for a further three years until developing the more classical adult presenting features of cognitive impairment, disordered gait and ataxia. The radiological and otological investigative findings are discussed, together with their implications.

Pathological lesions confined to the internal auditory canal (IAC) commonly present with cochleovestibular symptoms; sensorineural hearing loss, tinnitus and balance disturbance. The commonest lesion of the IAC is vestibular schwannoma. Other lesions include meningioma, facial neuroma, cavernous haemangioma, lipoma and arachnoid cyst. Presentation with facial palsy and an intracanalicular lesion is suggestive of pathology other than acoustic neuroma. Magnetic resonance imaging (MRI) cannot reliably distinguish intracanalicular vestibular schwannomas from meningiomas. Particular care is required for surgery of these lesions: the facial nerve typically does not lie in a protected anterior position within the IAC.

Functional endoscopic sinus surgery (FESS) is now a routine surgical procedure performed all around the world. A pre-operative computed tomography (CT) scan is considered mandatory in most countries where these are available but there are still some surgeons who question the need for imaging especially in patients due to undergo limited FESS or middle meatal antrostomy. There are excellent papers, describing how to read scans looking for anatomical abnormalities, but unfortunately their description of maxillary sinus hypoplasia and the associated uncinate process deformities are limited. This article describes two cases, one of unilateral and one of bilateral maxillary sinus hypopolasia (MSH) and discusses their implications. Awareness of these anatomical variants is crucial to avoid orbital complications.

A 72-year-old man presented with a history of progressive sleep apnoea. The cause was a large superior laryngeal nerve schwannoma arising in the left parapharyngeal space. This had a ball-valve effect on the laryngeal inlet. Superior laryngeal nerve schwannomas are very rare. No documented case has presented with obstructive sleep apnoea before.

A review of the literature reveals only 12 reported cases of laryngeal gout. We describe three further cases of laryngeal gout, the largest series ever published. The first case is previously undescribed acute gouty cricoarytenoiditis resulting in acute airway embarrassment requiring tracheotomy, and then we describe two cases of chronic tophaceous involvement of the thyroid lamina with computed tomography (CT) images of this process. The paucity of literature on this subject may not only be due to rarity but also lack of clinical awareness. Gouty involvement of the larynx must be considered in any patient with a history of gout who presents with hoarseness, odynophagia, dysphagia, stridor or neck lump.

Acute airway compromise may require tracheotomy, whereas chronic airway problems may necessitate endoscopic tophi removal, lateralization procedures or even permanent tracheostomy.

Tumours of the hypopharynx continue to have one of the most dismal prognoses of all tumours of the upper aerodigestive tract. These tumours are frequently advanced at the time of diagnosis. They have a particularly high propensity for lymphatic spread. Treatment, thus appears difficult from the outset. Although therapeutic protocols have improved, their often radical nature is synonymous with poor tolerance. With neoadjuvant chemotherapy and reconstructive surgery, cure has become a possibility for an increasing number of patients. However, sustained long-term remission following chemotherapy alone for advanced hypopharyngeal tumours has seldom been recorded.

Mucormycosis is caused by fungi of the order Mucorales and is one of the most rapidly fatal fungal infections known to man. Rhinocerebral mucormycosis is the most common type and its extension to the orbit and brain is quite usual. Location of mucormycosis on the palate is a rare and late occurrence.

A case of deep hard palate ulcer due to sinonasal mucormycosis in a 79-year-old man is reported. He was successfully treated with a combination of surgical debridement and systemic liposomal amphotericin B administration for six weeks.

By presenting this case report we would like to point out that mucormycosis should be included in the differential diagnosis of hard palate ulcers.

Firework injuries can manifest themselves in many different ways; usually as an explosive or burn injury. This case describes an unusual presentation of a firework penetrating injury resulting in a sharp coiled metal foreign body travelling through a small entry wound in the neck and subsequently lodging itself in the tracheobronchial tree. A foreign body such as this can potentially travel a considerable distance through the soft tissues and end up in an unsuspecting distant site. There must, therefore, be a high index of suspicion with the appropriate radiological investigations for appropriate management of such cases.