The indications for the ruling for the Gulf Forces that emergency cricothyrotomy is to be performed where the airway is thought to be compromised are reviewed. The advantages of this procedure are outlined and some of the likely consequences regarding the incidence of complications and their management predicted.

Histological studies of the auditory organ in patients with acquired hypothyroidism are scarce. Thus the aim of the present study was to examine the temporal bones and the brain is subjects with hypothyroidism. Four temporal bones and two brains from clinically and biochemically hypothyroid subjects were removed and evaluated by light microscopy determine to the morphological changes and deposition of neutral and acid glycosaminnoglycans. An audiogram from one of the patients showed a sensorineural hearing loss. Which could be ascribed to occupational noise exposure. The study revealed histological changes compatible with age and infectious disease. No accumulation of neutral or acid glycosaminoglycans could be demonstrated in the temporal bones, or in the brains.

This incidence of blast trauma to the ears in significant numbers is relatively rare in peace time. This paper outlines the results and management of twenty patients injured as a result of the outside explosion of 800 kg of high explosives in Peterborough on 22 March 1989.

This study was designed to confirm the longer in situ life of the Sheehy collar button compared with the Shepard tube and to assess the complication rate associated with the two tubes. Cases of bilateral otitis media with effusion had a Shepard tube inserted in one ear and a Sheehy contralaterally. The insertion position was allocated randomly. The patients were then assessed at three-monthly intervals for two years. In 71 percent of those in whom at least on tube had extruded, the Sheehy remained in situ longer. The antero-inferior tube remained longer than the postero-inferior whichever type was used. There was no significant difference between complication rates, or recurrence rates of middle ear effusion after tube extrusion, for the two types. We conclude that use of a Sheehy rather than a Shepard tube carries no increased risk of complications and the patient may require further surgery less often in total.

An analysis of 420 consecutive cases of obliterative otosclerosis seen in the Christian Medical College Hospital, Vellore is presented. The proportion of truly obliterative otosclerosis is 33.09 per cent (139 ears). Our male to female ratio in truly obliterative otosclerosis is 1.48:1, while in the non-obliterative group it was 1.34:1. The mean age at onset in the obliterative group was 19.14 while in the non-oblierative group it was 25.60. This is statistically (P<0.001). The age at presentation was 25.90 in the obliterative group while in non-obliterative group it was 30.86; this is also statistically significant (P<0.001). However the time interval between the age at onset and the age at presentation is not statistically significant.

Benign paroxysman positinal vertigo (BPPV) is a common condition which is usually self-limiting. Surgical treatment is rarely required and for many years the mainstay of such treatment has been singular neurectomy (posterior ampullary nerve section).

A new operation has recently been described for the treatment of BPPV involving occlusion of the posterior semicircular canal. We have performed this operation on five patients with intractable BPPV and report our result with follow up of between 12 and 36 months from operation.

The excellent results of posterior semicircular canal occlusion which have been previously reposted in the literature are confirmed by our experience. In our opinion the operation is a safe and effective alternative to singular neurectomy.

A study was understand in 43 patients to determine the role of surgery in tuberculous mastoidits. Cortical mastoidectomy was performed on five patients (Group I). Incision and drainage of a post-auricular abscess, removal of sequestrum and meatoplasty in eight (Group II).

Thirty patients had no ear surgery (Group III). Of the 17 Patients with facial palsy, three were in Group I, two in Group II, 12 in Group III. The patients in all three groups were treated with anti-tuberculous drugs for a period of no less than six months.

The average time taken for the otorrhoea to subside and granulation issue to resolve completely was two months in all three groups. The facial nerve recovery in the non-operated ears (Group I and II) 80 per cent.

The conclusion is that chemotherapy is the management of choice in tuberculous mastoidits. The only role of surgery is incision and drainage of a post-auricular abscess and removal of sequestrum if present.

A retrospective study comparing adverse events usin bismuth iodform paraffin paste (BIPP) and Xeroform as dressings for newly fashioned mastoid cavities after mastoidectomy was undertaken. There were 20 patients in each group. Adverse events were defined as offensive packs, mastoid caivity infection and systemic signs of infection. There were no adverse using BIPP packs Whether or not prophylactic antibiotics were used. Xeroform packs were associated with a significantly higher incidence of adverse events compared to BIPP when using on antibiotic porphylaxis (P<0.005) or amoxycillin (P<0.005). Adverse events with Xeroform packs were abolished using ciprofloxacin and metronidazole prophylaxis. We conclude that BIPP is the mastoid dressing of choice.

Cocaine is commonly used in ENT practice for its vasoconstrictor and anaesthetic properties. It is sometimes combined with adrenaline. The laser Doppler Flowmeter was used to compare the effect of 5 per cent concaine alone or with adrenaline (1 in 1,000) on nasal mucosal blood flow.

The results show an average fall in blood flow of 76.7 per cent for cocaine with adrenaline, compared to 61.2 per cent with concaine alone. The difference is significant (P<0.05). The time taken for the blood flow to fall was an average of 131 s and 160 s respectively. These differences are not significant.

From a series of 118 fronto-ethmoidal mucocoeles, 40 specimes have been submitted to detained histological analysis. The Frequency of each epithelial and sub-epithelial components is considered and reveals features which support a dynamic theory of bone resorption and formation rather than that of pressure erosion in the pathogenesis of mucocoeles.

Lymphangiomas of the tongue are rare tumours. Several reports of this interesting condition have appeared in the literature with varying modalities of treatment being employed to control tongue sizew. We present here our experinece with seven children who have lymphagiomas of the head and neck with tongue involvement seen over the past eight years. If the tongue is large with protrusion outside the lip margins, we advocata early tongue reduction so as to promote proper speech and deglutition, reduce of orthodontic problems and achieve good cosmesis. However, the naturel history of these tumours is one of recurrent tongue enlargement secondary to infection and trauman, irrespective of surgical reduction. We describe our technique of surface CO2 laser photocoagulation which has been successfully employed in controlling tongue size and removing superficial lymphangioma in all our patients. We propose therefore that this should be the mainstay of follow-up therapy in lingual lymphangiomas.

In this study we analyse our preliminary results after treating 28 patients with locally advanced laryngeal cancer with platinum based induction chemotherapy followed by radiation therapy or surgery.

The median age of our patients was 60 (46–75) years and median performance status was 80 (60–100). In 18 of the 28 patients locoregional treatment was radiation therapy with an overall response of 94.4 per cent.

After a median follow-up of 26 (15–40) months 39.3 per cent of the whole group of patients are alive and disease-free and six (21.4 per cent) patients are alive and disease-free preserving their larynx.

We conclude that although more extensive studies with large groups of patients and longer follow-up is needed to reach definite conclusions, it seems that platinum based induction chemotheraophy can be used successfully in locally advanced laryngeal cancer followed by radiotherapy. In those cases who respond well. the patient's larynx is preserved without compromizing the overall survival.

The disabilities following laryngectomy are well recognized. The incidence of these disabilities and the acceptability of the surgery to the patients were assessed by a questionnaire method. Sixty-five patients participated in the study. The incidence of disabilities are discussed. Total laryngectomy was felt to be a worthwhile operation by most of the patients in the study despite the disabilities they experienced afterwards.

Serum levels of immunosuppressive acidic protein (IAP) and other immunological parameters were examined in 95 head and neck cancer patients and 27 control patients. The mean values of IAP in patients in the advanced stage were significantly higher than in early stage patients. Statistically significant increases in the mean concentration of IAP were also observed in patients with a recurrence, as compared to findings in those in the advanced stages. The mean values of blastogenesis response to PHA and NK cell activity in the cancer patients were lower than in disease free individuals, but with no statistical differences. In the endstage patients, the lAP concentration was considerably elevated and the blastogenesis response showed a statistically significant decrease. Thus, the monitoring of serum lAP, in combination with other immunological parameters, aids in planning and assessing clinical staging in head and neck cancer patients.

We report the use of the ‘laryngeal box’, which permits instruction of a trainee in laser microlaryngeal surgery outside the operating theatre environment.

A case of orf affecting the pinna is discussed. This is an unusual presentation of aninfection that is common in farming communities.

At the initial presentation the diagnosis was not suspected, the management therefore was inappropriate and probably gave rise to the secondary infection that ensued. The history described is classical.

Orf affecting the external auditory canal has been reported once, but orf affecting the pinna has not been described before.

A rare middle ear tumour is reported. The clinical presentation was similar to that of a glomus tumour but the pathology that of an aggressive papillary middle ear tumour. This is a recently recognized subgroup of middle ear glandular tumours. Clinical findings, imaging, pathology and treatment are presented.

Carcinomas of the sebaceous glands of the skin are uncommon. These tumours metastasize frequently. A case of cutaneous sebaceous carcinoma localized in the postauricular region is presented with its exceptional large size and very poor prognosis.

Haemophilia A is a sex-linked inherited disease in which those affected are usually males, and females are usually asymptomatic carriers. This paper presents a haemophilia A carrier who has a low factor VIII level first, to remind readers that females can have low factor VIII levels with consequent increased tendency to bleed; second, to stress the importance of routine questioning regarding a bleeding tendency in the patient or the patient's family and third, to illustrate the importance of pre-operative diagnosis to allow adequate correction of the defect so that surgery such as adenoidectomy can be undertaken with safety in such a patient.

A case of sphenoid sinus mucocoele following radiotherapy in a patient with nasopharyngeal carcinoma is reported. Diagnosis was made by radiological investigation and confirmed at surgery performed via a sublabial transeptal approach. Its content was completely removed and continuous drainage of the sinus was maintained by an indwelling tube. It is felt that the sphenoid mucocoele developed as a result of occlusion of the sinus ostium by scarred mucosa following radiotherapy.