Previous reports from this department have established significant differences in the morphology of the nasopharynx between patients with otitis media with effusion (OME) and normal controls. This study has used lateral cephalometric analysis to investigate these differences in greater detail.

Skeletal and soft tissue measurements were recorded in 50 patients with bilateral OME and were compared with 50 age and sex matched normal controls.

Various points were plotted enabling 23 different linear dimensions and three angles in and around the nasopharynx to be compared. The results show significant differences between the two groups in the skeletal and soft tissue dimensions of the nasopharynx. The children with OME have a smaller nasopharynx with a suggestion that this may be due to a difference both in the rate and timing of growth.

Bismuth subnitrate, one of the constituents of BIPP is known to cause methaemoglobinaemia. Ten patients had blood estimations for methaemoglobin levels before and after nasal packing with BIPP impregnated gauze. Only one patient exhibited abnormal levels of methaemoglobin and this was most probably the result of the large quantity of BIPP used. It is unlikely that significant methaemoglobinaemia occurs during the routine use of BIPP in the nose.

Fifty members of a family with a unique autosomal dominant bone disease were investigated. Nineteen of the family members were either known to have, or were strongly suspected of having the disease. All but one of these had a hearing loss which was conductive in the younger age group and mixed in the older members. The common finding in those who had middle ear surgery was replacement of the long process of incus by a fibrous band. The histological features were similar to those found in Paget's disease. The age of onset, distribution of lesions and radiographic findings, however, were not typical of this disorder.

One fifth of patients selected for cochlear implants have such bony irregularities in the cochlear duct that full insertion of a multichannel electrode array is impossible. Three cases of cochlear deafness are presented where pre- and post-operative radiology played an important part in the management.

Standard CT at 2 mm cuts is compared with ultra high resolution CT at 1 mm cuts. The pitfall of poor definition is that the inexperienced surgeon may find himself unexpectedly drilling out an obliterated cochlear duct. Sections 30 degrees caudal to Reid's infra orbito-meatal base line at 1 mm intervals give maximum information for minimum radiation.

Plain films show the placement of individual platinum electrode contacts in relation to the spiral ‘frequency map’ of the cochlea. This is vital information for the audiologist who has to route specific frequencies to specific sites within the ear for a good hearing result.

Tinnitus is discussed, with particular reference to the problem of assessing severity. The authors argue that tinnitus severity can only usefully be determined by measuring the impact of tinnitus on an individual, and therefore propose a scale to estimate severity in these terms. Data presented on 112 members of a tinnitus self-help group, demonstrated the reliability of a Subjective Tinnitus Severity Scale (S.T.S.S.), with a coefficient alpha of 0.84. This indicates a high degree of internal consistency, i.e.: statistically this scale is measuring aspects of a single dimension. The validity was established in a separate sample of 30 clinic attenders, where mean S.T.S.S. scores were found to correlate highly with two independent clinical ratings of severity (r2 = 0.76, p<0.001, and r2 = 0.73, p<0.001). Additionally, in these patients S.T.S.S. scores were significantly associated with several audiometric variables, although the correlations were of low magnitude.

Four cases with Obstructive Sleep Apnoea Syndrome (OSAS) are presented. They consisted of two cases with TMJ ankylosis with micrognathia, one case with Treacher Collins Syndrome, and one case with the Long Face Syndrome.

Standard and specific cephalometric parameters were obtained to detect the site of the obstruction. Polysomnographic studies yielded information regarding the patient's sleep-wake state, respiratory and cardiac functioning, pre- and post-operatively. A temporary tracheostomy corrected the symptoms in one patient but the syndrome recurred when it was closed. Surgical correction of the maxillofacial anomalies will reestablish normal sleep patterns preventing OSAS.

This study examines the long-term results and morbidity of submandibular duct transposition in drooling children. Twenty-two patients, aged 3 to 18 years, with neurological dysfunction and excessive drooling underwent submandibular duct transposition between 1984 and 1987. In January 1990, 20 patients were reviewed. Their degree of drooling pre-operatively, immediately post-operatively and currently was assessed. The rate of improvement and the occurrence of complications were noted. Drooling was ‘much better’ in the early post-operative period in 17 of the 20 patients, and this improvement was invariably noted within three weeks. In the three other patients drooling was ‘better’. Deterioration occurred in only three patients over the entire follow-up period. Complications all occurred in the first 18 months following surgery; they consisted of salivary retention cysts in four and transient submandibular gland swelling in a fifth patient.

We present the results of a prospective study of 388 patients presenting with a history of swallowing a foreign body. We indicate whether the patients' symptoms and signs were associated with a retained foreign body. While tenderness on palpation was an unreliable sign, pooling at indirect laryngoscopy invariably predicted a retained object. In many patients, initial careful examination of the oropharynx by casualty officers would have shown a retained fishbone in the tonsil or tongue and would have resulted in 16 per cent fewer radiographs and 17 per cent fewer referrals to the ENT department. Radiography only improved management in a small minority and 35 per cent of films were interpreted incorrectly by casualty officers. A follow-up barium swallow disclosed a pathological lesion in a significant proportion of patients with bolus obstruction, whether or not this was passed spontaneously.

Previous studies have shown an increased frequency and duration of apnoeic episodes during sleep when the nose is occluded. The aim of this study was to ascertain whether oxygen desaturation occurs with nasal occlusion by postoperative packing. Continuous digital pulse oximetry was carried out before and after submucous resection of the nasal septum in 17 otherwise healthy patients. Post-operative nasal packing produced a statistically significant change in oxygen saturation during sleep. The change was, however, of such small magnitude that it is unlikely to be clinically significant.

A 65-year-old woman had suffered for two months from bilateral tinnitus and discharge, pain in the right ear, and loss of hearing. Biopsy showed carcinoma of the squamous type on both sides. Tomography revealed bone destruction on the right. The patient was treated with radiotherapy. Two months after treatment, tomography showed tumour regression on the right side, but progression on the left. The literature on this subject is reviewed.

An 18-year-old woman, while suffering from acute acquired toxoplasmosis, experienced sudden deafness and a total loss of vestibular function first in the right ear and three months later also in the left. Following treatment with sulphadiazine and pyrimethamine, hearing was retrieved to such a degree that the patient was enabled to communicate by means of a body-worn hearing aid and lip-reading. Taking the differential diagnostic possibilities into account, we believe that toxoplasmosis was the cause of the severe hearing loss. Since effective treatment seems to be available, we recommend that patients with acute bilateral sensorineural hearing loss of unknown origin are examined for acute toxoplasmosis with a view to instituting chemotherapy.

A case of meningitis secondary to acute suppurative otitis media in a previously healthy child is reported. The only organism isolated from blood after aerobic and prolonged anaerobic culture was identified as Fusobacterium necrophorum. Complete recovery followed treatment with surgery and prolonged antibiotic therapy. The role of anaerobes in the development of meningitis, the isolation and identification of Fusobacterium necrophorum, the clinical presentations of F. necrophorum infection and the choice of antibiotics in the treatment of these infections are discussed.

Primary carcinoma of the frontal sinus is extremely rare. The aetiology of the tumour remains obscure, and even with rapid diagnosis and radical surgery the prognosis remains very poor.

Two brothers with Wegener's granulomatosis are presented. HLA status and associated genes in the brothers and the immediate family are explored. No specific association could be found with tissue types within the family.

A case of post-cricoid carcinoma, occurring in a patient with Fanconi's anaemia is presented. The case illustrates the rare association of the two diseases. The problems with the management of such a case are discussed.

Intraeordal Teflon injection is commonly performed for recurrent laryngeal nerve palsy. It is generally agreed that injection should not be performed for a period of six months from the onset of an ‘idiopathic’ paralysis. A case is presented in which recovery occurred late, after intraeordal injection, with unfortunate results. Successful removal of the Teflon is described. The advisability of a longer wait before surgery for ‘idiopathic’ recurrent laryngeal nerve palsy is considered.

Malignant fibrous histiocytomas of the upper respiratory tract are rare, aggressive mesenchymal neoplasms. We report a case of a glottic malignant fibrous histiocytoma of the larynx on a 54 year old man. Only a few have been reported in the English literature. The clinical behaviour and degree of malignancy of these tumours cannot be predicted. Wide, aggressive excision of the tumour with a margin of normal tissue appears to be the treatment of choice. About two years after total laryngectomy the patient is well and free of disease.

Leiomyosarcoma of the larynx is extremely rare. A patient with respiratory obstruction due to such a tumour is presented. This was originally misdiagnosed as hysteria. The treatment of choice was an emergency laryngectomy.

A case report of pseudolymphoma of the parapharyngeal space is presented, together with a literature review of pseudolymphoma and management suggestions for such lesions when they occur in the head and neck. To the best of the authors' knowledge, this represents the first case report of pseudolymphoma presenting within the parapharyngeal space. The key to management of these lesions is based on accurate diagnosis, with differentiation of pseudolymphoma from lymphocytic lymphoma, the disease process which it mimics.

The standard teaching is that only malignant thyroid masses produce recurrent laryngeal nerve palsy. An unusual exception to this rule is reported.