Following informed parental consent 93 children underwent bilateral grommet insertion. Tympanometry was performed pre-operatively, and immediately prior to myringotomy. A standardized anaesthetic was used. At myringotomy the presence or absence of fluid was recorded, as well as the time since induction of the general anaesthetic.

A pre-operative type B tympanogram predicted a middle-ear effusion at myringotomy in 92 per cent of patients. A pre-operative type C2 tympanogram predicted a middle-ear effusion at myringotomy in 39 per cent of patients. Sixty tympanograms (30 per cent) changed following a general anaesthetic. Fourteen type B tympanograms changed to type A and eight of these had effusions. The duration of the general anaesthetic did not influence the probability of a middle-ear effusion being present at myringotomy. A pre-operative type B tympanogram is a good predictor of middle-ear fluid. The duration of the general anaesthetic is not significant in predicting the presence of a middle-ear effusion.

Thirteen cadavers (26 temporal bones) were examined to show the arcuate eminence, especially its correspondence to the superior semicircular canal and inferior surface of the temporal lobe. Arc-like eminences on the petrous bone were observed in 92 per cent of specimens, however, they did not exactly correspond to the superior semi-circular canal. Some eminences corresponded to sulci of the temporal lobe of which most were traces of the occipitotemporal sulcus.

On the other hand, a dull, smooth and even domed eminence existed in nine temporal bones independently of the arc-like eminence. Those eminences corresponded to each superior semi-circular canal in only three out of nine specimens.

The arcuate eminence was listed as an important landmark in the middle cranial fossa approach. However, in order to drill out the internal auditory canal safely, surgeons should rely on other landmarks or apply other methods from our data.

The prevalence of asymmetrical hearing impairment in the entire service population (1490 individuals) of a Royal Air Force flying station was estimated from routine audiometric testing recorded in individuals’ medical records. Criteria for magnetic resonance imaging (MRI) scanning to exclude the possibility of vestibular schwannoma were determined in accordance with the risk management principle that the cost of the screening should not exceed the value of the likely benefit. MRI scanning should be carried out in the presence of an asymmetrical sensorineural hearing impairment of (a) 15 dB or more at two adjacent frequencies, or (b) 15 dB or more averaged over 0.5, 1, 2, 3, 4, 6 and 8 kHz.

Polyps of the maxillary sinus were obtained from six patients who had reported upper tooth extraction with oroantral perforation prior to the development of symptoms, from 11 patients with chronic sinusitis, and from 12 patients with allergy. Histopathological features, scanning electron microscopy of the polyp epithelium and clinical data were compared in those groups of patients. The post-traumatic polyps differed from those of other aetiologies by showing the presence of granulomas, less numerous inflammatory cells with very few eosinophils, nearly normal surface epithelium (smaller surface area occupied by nonciliated epithelium, absence of epithelial squamous cells, normal frequence of goblet cells), rapid appearance of symptoms, and shorter duration of the disease. It seems that the specific characteristics of the injury-induced polyps results from a different mechanism of their formation, involving primarily abnormal mucosal repair and to a lesser extent an inflammatory process.

A prospective study was carried out on 52 patients with allergic rhinitis, during March 1993–January 1995. This was to analyse the occurrence of bronchial asthma among them and to correlate the symptoms, signs and pathological findings of allergic rhinitis with that of bronchial asthma in those patients with both the disorders. The therapeutic benefits with regard to the symptoms of bronchial asthma in these patients were assessed after treatment of their nasal allergy for a period of at least four months.

A definite aetio-clinico-pathological correlation could be established between allergic rhinitis and bronchial asthma and it could be concluded from the study that prompt attention to nasal symptoms in cases with co-existent bronchial asthma helps to a large extent in curbing the symptoms of the latter.

The problem of the therapy of glottal and neoglottal insufficiency is still unsolved. The surgical techniques and the materials employed up until now are not completely free from possible partial or total failures, early or late complications, or the need of a second operation. The objective of the study is to introduce a new thyroplasty technique of inserting tubular expanded polytetrafluoroethylene (e-PTFE) into the larynx of an animal model, with the purpose of using it next in human laryngeal tissue augmentation. Seven 30 kg pigs had tubular e-PTFE implanted under endoscopic control into a vocal fold or laryngeal vestibule. The implants were secured by suture to the thyroid cartilage. Short-term results demonstrate the ease and effectiveness of this mini-invasive implant surgical technique. Long-term follow-up is underway in anticipation of applying this technique to human laryngeal tissue augmentation.

Endoscopes require repeated cleaning and application of antimist solution during surgery. A novel, simple and inexpensive method of application of the antimist solution is described.

We present the case of a 58-year-old diabetic renal transplant patient who developed a left jugular foramen syndrome, secondary to an ipsilateral staphylococcal malignant (necrotizing) otitis externa. This followed a protracted episode of uncomplicated otitis externa with no evidence of bone involvement on computed tomography (CT) scanning. Cyclosporin-induced hypertrichosis (excess hair growth) in his external auditory canal contributed greatly to the initial difficulty in managing his otitis externa. Following an initial successful treatment with prolonged intravenous antibiotics the patient relapsed with a secondary infection in the same anatomical site due to Candida parapsilosis. Despite further intensive treatment including antimicrobials, a subtotal petrosectomy and hyperbaric oxygen therapy he eventually succumbed to his disease.

Primary paraganglioma of the external auditory canal is a rare otological finding. To date, only three cases have been reported in the world-wide literature. Such a tumour is now described in a 42-year-old female. The clinical and histopathological features of the case are discussed. The role of immunocytochemistry in defining diagnosis, from a large list of differentials, is illustrated. We present the first magnetic resonance images of this rare tumour and highlight the benefit of intra-operative frozen section in limiting surgery to canal excision.

A case of an eight-month-old girl with an abscess in the temporomandibular joint as a complication of acute otitis media is described. The complications of acute otitis media in general and the probable explanation for the development of this complication are discussed.

A case is reported of swelling over the mastoid process due to subgaleal abscess possibly secondary to trivial cutaneous trauma. The diagnosis was difficult as subgaleal abscess is an extremely rare condition especially after the advent of the antibiotic era. The route of entry of the infection to the subgaleal space was unclear as there was no skin puncture. The absence of substantial trauma excluded subgaleal haematoma as a precondition. We would like to discuss the possible aetiologies and the management of this rare case in the light of the limited information available in the world literature.

Plasma cell tumours of the mastoid are rare malignancies of haematological origin. Two patients are described with a plasma cell tumour in the mastoid bone. In one patient it concerned a solitary plasmacytoma of the bone and in the other a focus in the mastoid of a recently diagnosed multiple myeloma. Symptoms in these patients were non-specific. Computed tomography (CT) and magnetic resonance image (MRI) scanning showed a nonspecific space-occupying lesion in the mastoid. The diagnosis was made on immunohistological examination, that showed diffuse sheets of monoclonal plasma cells in a clear matrix. When a plasmacytoma lesion is found multiple myeloma should always be excluded. Treatment in case of solitary plasmacytoma of the mastoid bone consists of radiotherapy. In case of localization in the mastoid of multiple myeloma the treatment consists of palliative chemotherapy.

Angiosarcomas are rapidly growing malignant neoplasms arising from the vascular endothelial cells. Most common sites are the extremities and the retroperitoneal space, with only four per cent of angiosarcomas arising in the head and neck area, whilst the paranasal sinuses are one of the rarest locations. We report the case of a maxillary sinus angiosarcoma in a 72-year-old male patient. The first biopsy was inconclusive, whereas the second revealed an angiosarcoma. Medial maxillectomy was performed with subsequent external irradiation.

Isolated sphenoid fungal sinusitis is a rare and often difficult to diagnose condition as the presenting symptoms are often vague and non-specific. In this series each case has a different clinical presentation with a different causative fungus. Although isolated fungal sphenoid sinusitis is usually seen in immunocompromised individuals, two of the three cases presented were immunocompetent. The fungi were Pseudallescheria boydii, Aspergillus fumigatus and Schizophyllum commune. In order to illustrate the great diversity of clinical signs, each case is individually presented. The characteristic radiological signs and the clinical management of each case are also presented. The danger signs of associated pathology are discussed with particular reference to an associated squamous carcinoma in one case. Surgical options and chemotherapy are discussed. Isolated sphenoid fungal sinusitis is a rare condition that if undiagnosed may result in considerable morbidity and even mortality of patients.

Paragangliomas can develop in a number of head and neck sites, the most common being the carotid body paragangliomas and glomus jugulare tumours. This is a case of a paraganglioma confined entirely within the lumen of the jugular vein.

Narrow internal auditory canal (IAC) syndrome is a malformation of the temporal bone, that is defined as an IAC diameter of only 1–2 mm on high-resolution computed tomographic scans (HRCT). This syndrome is known to be caused by the absence (aplasia or hypoplasia) of the vestibulocochlear nerve. We present a case of unilateral narrow IAC syndrome which was diagnosed by HRCT. The aplasia of the vestibulocochlear nerve was confirmed using parasigittal reconstruction magnetic resonance image (MRI). The IAC was composed of two separate canals, one of which contained a facial nerve and the other was empty with aplasia of the vestibulocochlear nerve.

Computerized tomography (CT) offers the gold standard in terms of imaging the extent of disease and the fine detailed anatomy, both pre-requisites to the safe practice of endoscopic sinus surgery. Neither plain X-rays nor magnetic resonance imaging (MRI) offer optimal information in this respect. A variety of protocols minimizing radiation dose to the lens whilst providing high quality images are presented together with a menu of anatomical features that require careful evaluation pre-operatively.