For the 40 per cent of patients with head and neck cancer who present with stage I and II disease either radiotherapy or surgery can be curative. The remaining 60 per cent have advanced loco-regional disease and even when treated with surgery and radiotherapy the five-year survival is less than 30 per cent. Most patients with relapse have loco-regional disease and second primary tumours have an incidence of three per cent a year.1 Current attempts to improve prognosis include the addition of chemotherapy, the use of brachytherapy and accelerated radiotherapy regimes such as continuous hyperfractionated accelerated radiotherapy (CHART).

Schwannomas are peripheral nerve tumours of nerve sheath origin. We report one case of cervical schwannoma originating from the brachial plexus. A 56-year-old man presented with a slow-growing mass on the right side of his neck that had been noted for more than 10 years. During operation, a wellencapsulated mass was seen beneath the brachial plexus with adhesion to the plexus element. It was reported as a schwannoma. Three days after surgery, the patient had a motor deficit of the right upper arm and neurological examination showed a CV nerve deficit. The neurological function recovered completely after three months. In addition, the other five cases of cervical schwannoma seen in our hospital between March 1990 and June 1998 are also reviewed. All patients had surgery. The pre-operative symptoms, impressions, and post-operative neurological status were shown and discussed. Only two cases were diagnosed as neurogenic tumour pre-operatively. Post-operatively, one patient had transient neurological deficit and another one had permanent deficit.

This was a study of the history of the technological development of air conduction hearing aids, and a review of international literature on the subject. The technological evolution of amplification devices, from their origin to the present day, can be divided into seven distinct periods: the period of sound collectors, the period of hearing devices constructed from carbon, the period of vacuum tubes, the transistor period, the period of integrated circuits, the microprocessor period and the period of digital hearing instruments. Throughout these different stages, hearing instruments have progressively developed reaching their present state.

The current era is itself undergoing constant development and change. With the introduction of new technologies, we expect that the rate of change will increase rapidly in the future.

Osteogenesis imperfecta (OI) is a connective tissue disorder characterized by osseous fragility, blue sclerae and hearing loss. In order to assess the impact of stapedotomy on improving hearing on OI, a retrospective, one-group, pre-test-post-test design was used to compare the pre-operative and postoperative audiograms of nine OI patients, treated with stapedotomy for their mixed hearing loss. Operative findings included fixation or thickening of the stapes footplate with normal superstructure configuration and hypervascularization of the promontory mucosa. Immediate post-operative results showed a significant improvement (p<0.05) from 250–4000 Hz in air conduction and from 250–2000 Hz in bone conduction. A significant closure of the air-bone gap between 250–2000 Hz was also achieved (p<0.05). The long-term results remained satisfactory with a mean threshold shift of 8 dB HL and an almost unchanged air-bone gap. These satisfactory results and the lack of complications make stapedotomy an appealing method for the management of OI-associated hearing loss.

The purpose of this study was to evaluate the long-term effect on middle ear and eustachian tube function following the packing of the middle-ear space to prevent cerebrospinal fluid rhinorrhoea at the termination of translabyrinthine vestibular schwannoma removal.

This was an observational study of a sample of 14 patients examined between two and five years postoperatively. Photo-otoscopy and tympanometry were performed bilaterally to evaluate appearance and function.

All operated middle ears were air-containing although eight out of 14 showed scarring as evidence of operative intervention. There were no drum retractions. Ten out of 14 middle-ear compliance peaks were lower in the operated ear with four flat traces. Two out of 14 were the same and two out of 14 showed high compliance. The middle-ear pressure was always within the normal range when determinable.

This technique appears to have no detrimental effects on the middle ear and does not permanently obliterate the eustachian tube. The reduced compliance in the majority of cases is probably a result of scarring and fibrosis. When drum hypermobility is seen this is accounted for by incus removal.

Burow’s solution (13 per cent aluminium acetate) has been found to inhibit in vitro the growth of most commonly occurring bacteria found in the discharging ear. An in vitro study has shown that the minimum inhibitory concentration of Burow’s solution for these organisms lies between a 1:80 and a 1:160 dilution. This paper reports on a clinical trial that incorporated 67 discharging ears to establish the most effective strength of aluminium acetate solution. There was no statistical difference in the effectiveness of full strength Burow’s solution compared to 3.25 per cent aluminium acetate solution (a quarter strength Burow’s solution). Response rates of 80.8 per cent and 75 per cent respectively following a two-week treatment period were achieved using these two solutions. A 1.3 per cent aluminium acetate solution (1/10 strength Burow’s solution) was found to be markedly inferior. Bacteriological and audiological profiles were recorded for each patient.

Contact endoscopy is a technique of obtaining detailed magnified images of living epithelium, using a modified glass rod lens endoscope placed on the surface of the tissue. The technique has been extensively described in gynaecological, and more recently, laryngeal and nasal tissues. However, no quantitative studies of its diagnostic accuracy yet exist. A prospective partially blinded controlled study of eight cases with a variety of laryngeal pathologies is described. A single pathologist with no knowledge of the ultimate histological diagnoses successfully identified six of eight laryngeal pathologies on contact endoscopic findings, while the other two cases were identified to a degree of accuracy that was sufficient to positively identify the need for standard tissue biopsy. The advantages and disadvantages of the technique are described, along with suggestions for its role in clinical practice.

A review of a combined gastroenterology and laryngology clinic was conducted to determine the effectiveness of treatment and the predictive value of clinical findings and investigations.

Data were collected prospectively. Investigations were performed according to clinical criteria. Patients with symptoms suspected to be due to laryngopharyngeal reflux (based on a positive oesophageal pH test and/or changes on videolaryngoscopy consistent with posterior laryngitis) were treated with omeprazole for at least two to three months.

There were 87 patients; the most common symptoms were cough (38 per cent) and hoarseness (36 per cent); 77 per cent had some symptoms suggestive of gastro-oesophageal reflux. Sixty-seven patients were given omeprazole. A good response to laryngo-pharyngeal symptoms was seen in 37 patients (55 per cent). The presence of reflux symptoms was not a predictor of a good response. Increasing severity of oesophageal acid exposure over the 24 hours of pH testing was associated with a better symptom response (Spearman rank correlation, p = 0.01). Posterior laryngitis was not associated with the response to treatment, although there was a trend towards an association between improvement in laryngitis (after treatment) and improvement in symptoms (p = 0.08).

The response to proton pump inhibitors was lower than other published results. Oesophageal pH monitoring may have a role in predicting which patients will respond to proton pump inhibitors. This study does not support the decision to treat with anti-secretory therapy, based only on the presence of posterior laryngitis.

Grommet insertion is one of the commonest surgical procedures performed in the UK. We have come across three cases in which grommets have displaced medially in the middle ear after establishing a satisfactory postinsertion position. We suggest that an abnormally long myringotomy incision and improper placement of the grommet are responsible for this unwanted outcome.

The authors report a case of myiasis of the middle ear caused by Wohlfartia magnifica Schiner (Diptera: Sarcophagidae). The entomological aspects, the clinical epidemiological characteristics and the therapeutic solutions of this disease are evaluated. In particular, they underline the rarity of myiasis both because of the aetiologic agent and the anatomical site. The therapeutic aspects are also reported and discussed.

Cavernous haemangiomas are rare lesions of the cerebello-pontine angle that can mimic the more commonly occurring vestibular schwannoma. A case report involving a patient with a cavernous haemangioma of the internal auditory canal (IAC) highlights this as a diagnostic possibility for lesions of the IAC by comparing and contrasting the clinical and radiological findings with the more commonly occurring vestibular nerve and facial schwannomas.

Symptoms such as hearing loss and facial paralysis that are disproportionate to the size of the lesion or fluctuate with hormonal changes such as those seen in pregnancy are suggestive of haemangioma. Radiological imaging demonstrating a lesion enchancing with gadolinium and containing areas of calcification is also suggestive of haemangioma. It is important to consider the possible diagnosis of haemangioma as early recognition of this entity may improve the chances of preserving the functional integrity of the facial nerve.

The main cause of sinus pathology is disease in the middle meatus, therefore, unless nasal drops are deposited in this site they will not be effective. Currently, one of three standard head positions are used by patients for the instillation of nasal drops, ‘head back’, ‘praying to Mecca’, and ‘Mygind’s’, all are uncomfortable and only one, Mygind’s position, effectively deposits the drops in the middle meatus.

In this paper, we review these three positions by utilizing a preserved cadaver head and conducting a simple gravitational flow study using white liquid latex as a nasal drop substitute. We also describe a new fourth ‘Ragan’ position, on the side, head down, that is effective in consistently delivering nasal drops into the middle meatus and should prove a most comfortable position for patients to adopt.

Juvenile xanthogranuloma is a benign, normolipaemic, self-healing condition and a type of histiocytosis that occurs most frequently in infants and children. This condition usually presents with solitary or multiple cutaneous lesions and occasionally with visceral lesions. We report a case of juvenile xanthogranuloma occurring in the nasal cavity. We believe this is the first report, in the English literature, of juvenile xanthogranuloma occurring in this site.

Before contemplating surgery for cerebrospinal fluid (CSF) rhinorrhoea it is vital that the correct diagnosis is established. This can be done using immunofixation of beta-2-transferrin, that is nearly always positive in cases of CSF rhinorrhoea. Fluorescein lumbar puncture is useful in establishing the exact site of a leak and also in confirming the absence of a leak where the clinical suspicion is high but the beta-2-transferrin is negative. High resolution computed tomography (CT) scanning is a useful radiological investigation for identifying a bony defect. We present nine patients who presented with clear rhinorrhoea that was clinically highly suggestive of a CSF leak. Three of these patients had undergone previous craniotomies for presumed CSF rhinorrhoea. The diagnosis of CSF rhinorrhoea was excluded in all patients using beta-2-transferrin with or without fluorescein lumbar puncture. The authors believe that measurement of beta-2-transferrin should be mandatory before surgery for CSF rhinorrhoea.

We report the first case of a lipoma originating in the fossa of Rosenmu¨ ller. Although lipomas are a common benign tumour in the body, lipomas of the nasopharynx are rare.

Oesophageal ulceration is an unusual complication of doxycycline treatment (Vibramycin®) presenting to an Otorhinolaryngology department. A case report is presented with discussion of investigations and management of the patient.

An unusual extremely benign course of an 8 cm long, rusting, metallic oropharyngeal foreign body that had entered post-aurally (penetration injury) four years previously to lie completely within the pharyngeal lumen has not yet been reported in the world literature. The need for additional investigations and special precautions to be taken during surgical extraction are highlighted.

The uncommon occurrence of acute retropharyngeal abscess in adults can be the result of a retained foreign body. A large piece of wood impacted in the neck in a road traffic accident and presenting as retropharyngeal and bilateral parapharyngeal abscesses is reported for its rarity and clinical interest.

An unusual case of Echinococcus oligarthrus infestation of the submandibular salivary gland is reported. Echinococcus oligarthrus is a rare variant of the Echinococcus species affecting humans. To the best of our knowledge only one case of submandibular hydatid cyst caused by Echinococcus oligarthrus has been reported. A 28-year-old female patient was admitted with a progressively increasing swelling in the left submandibular region of four years’ duration. There was no pulmonary or hepatic involvement. The present case of submandibular hydatid cyst caused by Echinococcus oligarthrus is of interest because of the unusual site of the disease.