Nasal inspiration is important for maintaining the internal milieu of the lung, since ambient air is conditioned to nearly alveolar conditions (body temperature and fullysaturated with water vapour) upon reaching the nasopharynx. This literature review of the existing in vivo, in vitro and computational studies on transport phenomena that take place within the human nasal cavity summarizes the current knowledge on air-conditioning characteristics of the human nose.

Otitis externa (OE) and especially otomycosis can be very persistent and difficult to control. In the present study the efficacy of treatment of OE with a single instillation in the ear canal of one per cent silver nitrate in three per cent hypromellose gel compared to 0.1 per cent silver nitrate gel was tested in a single-blinded randomized controlled parallel group study. The outcome measure was complete resolution of the OE after one week. Forty-four patients with refractory, bacterial as well as fungal, OE entered the study, comprising 30 ears in each treatment arm. Eight patients defaulted from follow-up,five ears in each treatment arm. A single instillation of one per cent silver nitrate gel cured 23 (92 per cent) of 25 ears with OE, whereas with 0.1 per cent silver nitrate gel seven (28 per cent) of 25 ears treated were cured (Fisher-exact test, p-exact = 0.00010). In a non-controlled series of 120 ears 93.3 per cent needed only a single instillation of one per cent silver nitrate gel while another five per cent were cured after a second instillation a week later. There were no adverse reactions. OE can be treated effectively with instillation of one per cent silver nitrate gel and is particularly useful in recalcitrant otomycosis. The treatment method saves both cost and time.

In this study, the anti-inflammatory effect of erythromycin was investigated in a model of histamine-induced otitis media with effusion (OME). OME was induced in guinea pigs by the transtympanic injection of histamine solution into the middle-ear cavity. Guinea pigs were randomly assigned to one of three groups: control, erythromycin treatment, or methylprednisolone treatment. After histamine injection, the animals were treated with intraperitoneal medication for five days consecutively. Afterwards, the animals were sacrificed and the temporal bones were removed. The samples were examined stereologically.

In the erythromycin-treated group, it was observed that neutrophil infiltration was significantly inhibited when compared to the control group. This result shows that erythromycin may produce a significant anti-inflammatory effect in this model of OME.

The aim of this study is to compare the scintigraphic results of a denervated submandibular gland with the contralateral normal side in patients with unilateral chorda tympani damage. Sixteen patients (11 women and five men with a mean age of 27) with unilateral proven chorda tympani damage during their previous ear surgery were included in the study. The perfusion ratio (PR), concentration ratio (CR) and stimulated excretion ratio (SER) were calculated scintigraphically and the results from the salivary glands on opposite sides were compared.

For submandibular glands, the perfusion ratio (PR), concentration ratio (CR) and stimulated excretion ratio (SER) were found to be 0.65 ± 0.21, 0.70 ± 0.21, 0.79 ± 0.37, respectively. All ratios resulted from statistically decreased radioactivity accumulation on the affected side (p<0.05).

Chorda tympani damage negatively affects the function of the ipsilateral submandibular glands despite the absence of atrophy. Dynamic salivary gland scintigraphy is a practical and valuable method of disclosing the decreased capacity of perfusion, concentration and secretion function in unilateral neurological deprivation.

The quantitative relationships between the position of the mastoid segment of the facial nerve, mastoid pneumatization and the positions of neighbouring structures are undetermined. Using high resolution computed tomography (HRCT), the positions of these structureswere measured in 66 normal temporal bones. A new method for measuring the volume of pneumatization in the temporal bone based on the serial digital images of CT was designed. The method of partial correlation analysis was used to find the real relationship of the two variables. The results suggest that the factors that influence the position of the mastoid segment of the facialnerve are complicated and multiple. The development of the cranium including the temporal bone,the temporal bone pneumatization and the variable position of the jugular bulb are considered to be important factors.

A novel auditory brainstem response (ABR) detection and scoring algorithm, entitled the Vector algorithm is described. An independent clinical evaluation of the algorithm using 464 tests (120 non-stimulated and 344 stimulated tests) on 60 infants, with a mean age of approximately 6.5 weeks, estimated test sensitivity greater than 0.99 and test specificity at 0.87 for one test. Specificity was estimated to be greater than 0.95 for a two stage screen. Test times were of the order of 1.5 minutes per ear for detection of an ABR and 4.5 minutes per ear in the absence of a clear response. The Vector algorithm is commercially availablefor both automated screening and threshold estimation in hearing screening devices.

The contribution of air conduction auditory brainstem response (AC-ABR) testing in the paediatric population is widely accepted in clinical audiology. However, this does not allow for differentiation between conductive and sensorineural hearing loss. The purpose ofthis paper is to review the role of bone conduction auditory brainstem responses (BC-ABR). It is argued that despite such technical difficulties as a narrow dynamic range, masking dilemmas, stimulus artifact and low frequency underestimation of hearing loss, considerable evidence exists to suggest that BC-ABR testing provides an important contribution in the accurate assessmentof hearing loss in infants. Modification of the BC-ABR protocol is discussed and the technical difficulties that may arise are addressed, permitting BC-ABR to be used as a tool in the differential diagnosis between conductive and sensorineural hearing. Two relevant case studies are presented to highlight the growing importance of appropriate management in early identification of hearing loss. It can be concluded that BC-ABR should be adopted as a routine clinical diagnostic tool.

Noise exposure, hearing loss and associated otological symptoms have been studied in a group of 23 disc jockeys using a questionnaire and pure tone audiometry. The level of noise exposure in the venues where they work has also been studied using Ametek Mk-3 audio dosimeters. Three members of the study group showed clear evidence of noise-induced hearing losson audiometry, 70 per cent reported temporary threshold shift after sessions and 74 per cent reported tinnitus. Sound levels of up to 108 dB(A) were recorded in the nightclubs. The average level for a typical session was 96 dB(A) which is above the level at which the provision of ear protection is mandatory for employers in industry. It can be concluded that DJs are at substantial risk of developing noise-induced hearing loss and noise exposure in nightclubs frequently exceeds safe levels.

The operation of septoplasty is often given to junior surgeons to perform and dismissed as a simple procedure. This can lead to unsatisfactory results with unnecessary morbidity for the patient and disillusionment for the surgeon. Trainee surgeons feel that the operation of septoplasty is poorly taught. Some common problems encountered during septal surgery are described and a variety of surgical solutions are offered.

It has been shown that computerized sound frequency analysis can be used todistinguish between different snoring sites. The aim of this study was to investigate whether aportable recording method using audiotapes and digital minidisc formats could produce waveformssimilar to a computer recording.

The snores of 12 subjects in their natural sleep were recorded onto audiotape, minidisc and directly onto a computer. For each snorer and recording method 30 snore samples were analysed and their power ratio was calculated indicating the relative amount of sound below and above a set frequency. It was found that the power ratios from audiotape recordings were significantly different to those from computer recordings for all snoring sites (p = 0.0007), whereasthere was no significant difference between minidisc and computer recordings (p = 0.41).

These results indicate that it would be possible to base a portable snore analysis system for site determination on minidisc, but not on audiotape recordings.

The non-recurrent inferior laryngeal nerve (NRILN) is a nerve anomaly that can be associated with an increased risk of vocal fold paralysis. The purpose of this study wasto report three new cases of this anomaly, underline the necessity of recognizing its possibility for the prevention of intra-operative nerve damage and a review of the literature.

Three cases of thyroid surgery associated with right NRILN are reported.

Two patients underwent bilateral thyroidectomy for a multinodular goitre and for a toxic multinodular goitre respectively. The third patient had a right lobectomy and isthmectomy for a thyroid nodule. All patients had identification of the recurrent laryngeal nerve on the left sideand NRILN on the right side. The diagnosis of the NRILN was made per-operatively on all cases. A post-operative computed tomography (CT) scan in two patients, showed a retrooesophageal aberrant right subclavian artery. Post-operatively, all patients had normal vocal fold function on laryngoscopy.

The NRILN is a rare anomaly but overlooking its possibility may lead to severe operative morbidity. This is an additional argument in favour of systematic dissection of the recurrent inferior laryngeal nerve during thyroid surgery.

We report a case of sudden hearing loss in a patient with acute exudative tonsillitis, occurring 15 minutes after the intramuscular administration of penicillin. Audiological evaluation documented a profound sensorineural hearing loss of the cochlear type. The mechanism of the hearing loss was probably an immediate hypersensitivity (type I) allergic drug reaction. Penicillin is used frequently for the treatment of several infections. Allergic reactions to penicillin are well known and include urticaria, maculopapular exanthems, angio-oedema, bronchospasm and anaphylaxis, but sudden hearing loss has never been recorded.

An interesting case is presented of a 53-year-old male who was seen with a 10-year history of intermittent, unilateral nasal obstruction following a bilateral total inferior turbinectomy. A pedunculated mass was seen in the right posterior nasal space acting as a ball valve. This was removed and found to be residual turbinate tissue.

A case of oesophageal obstruction following the removal of a tracheoesophageal valve by division is presented. The obstruction was caused by impaction of a portion of thevalve at a previously undiscovered benign oesophageal stricture. The obstruction was resolved by interventional radiology with no long-term sequelae. To the best of our knowledge this complication has not been described previously.

Aneurysms of the extracranial portion of the internal carotid artery are rare, particularly in young patients. They usually develop following trauma, or secondary to infection involving the parapharyngeal space that extends to the vessel wall. This is a case of an internal carotid artery aneurysm presenting acutely following chiropractic neck manipulation with hypoglossal and glossopharyngeal nerve palsy. The imaging findings and subsequent operative management are described.

A case is presented where a left jugulotympanic paraganglioma (JTP) extended to the nasopharynx and the patient presented with recurrent epistaxis. Although initial biopsy of an aural polyp had been suggestive of the diagnosis several years previously, the diagnosis was not confirmed until the patient presented with recurrent epistaxis and severe anaemia. Tothe best of our knowledge, this is the first case reported of such a presentation of JTP.

Neurilemmomas are slow growing, benign neoplasms of neural crest Schwann cell origin. They arise from any peripheral, spinal or cranial nerve except the olfactory and optic. Presentation is usually asymptomatic but focal neurological signs and symptoms may be associated with nerve compression. With approximately one third of all documented cases presenting in the head and neck region, we report a case of a submandibular neurilemmoma misdiagnosed pre-operatively. The diagnostic difficulties are discussed and the current literature reviewed. Thiscase highlights the importance of inclusion of nerve sheath tumours in differential diagnoses of soft tissue lesions in the head and neck.

A previously undescribed association of Reidel’s thyroiditis with Tolosa-Hunt syndrome is reported. A 33 year-old Caucasian female presented with a two-year historyof painful progressive goitre, histologically a Reidel’s thyroiditis. She underwent left partial thyroidectomy. Post-operatively she developed severe right retro-orbital pain, right temporal headache and a partial right occulomotor nerve palsy. A diagnosis of Tolosa-Hunt syndrome was made. Some important aspects of this case are discussed.

Parathyroid carcinoma is a rare tumour, which is often difficult to diagnose. This is especially true in patients with pre-existing tertiary hyperparathyroidism of end-stage renal disease. A case is presented of parathyroid carcinoma in a haemodialysis patient withunusual thymic involvement. After demonstrating the difficulty in pre-operative diagnosis and risk of recurrence, the importance of non-surgical treatment options is discussed and the investigation of individual tumour chemosensitivity is introduced, which is new to this type of cancer.