Qualitative and quantitative bacterial analysis of 200 samples of middle ear effusions collected from patients with current otitis media was performed. When middle ear pathogens (S. pneumoniae, H. influenzae and B. catarrhalis) where found during current acute otitis media or otitis media with effusion infection, the quantity of these bacteria was of the magnitude 106–108/ml and 0–5 × 105/ml effusion material, respectively. Mucopurulent effusion material contained 6 × 105–108 bacteria per ml whereas effusion from chronically discharging ears exceeded 109 bacteria per ml. Serous effusions did not harbour middle ear pathogens. The appearance of the effusion material was dependent on the number of bacteria involved. Quantification of bacteria in various middle ear effusions offers opportunities to make the diagnosis of various otitis media infections more accurate and readily comparable.

Fifty-nine type 1 tympanoplasties in children under 14 years of age were assessed by recall to a special follow-up clinic up to 15 years post-operatively. Overall 78 per cent of tympanic membranes were found to be intact with a late failure of grafts noted in 6 per cent of cases. An improvement in the audiological threshold was found in 51 per cent, 24 per cent were unchanged, the remaining 25 per cent suffered a deterioration which was seen both immediately post-operatively and thereafter until reviewed in the special clinic. The age at operation, size of the perforation, grade of surgeon carrying out the operation and prior adenoidectomy had no statistically significant influence on the success rate or the audiologicaloutcome. Revision procedures achieved similar graft take rates to the initial procedures but fared worse audiologically. We conclude that in the majority the operation was successful but hearing gain was not as good as expected and subject to late deterioration. A long term follow-up is important to detect this and other complications.

The best method of providing waterproof protection for susceptible ears remains a contentious issue. Many evaluations have concentrated on the efficacy of intraluminal plugs in normal or model ears. We describe a new method, using a jejunostomy shower cap (Dansac mini cap®), which avoids intraluminal insertion.

This method has proved useful in some patients who have failed to avoid repeated otorrhoea after water exposure despite using a wide range of intraluminal ear plugs. The shower caps are best avoided in children because of teasing.

Benign primary tumours of the facial nerve are uncommon. A slowly progressive facial palsy should be considered the result of a nerve tumour untilproven otherwise.

Improvements in diagnostic imaging techniques of the temporal bone have increased the possibility of a correct pre-operative diagnosis but facial nerve tumours remain a frequently ignored or misdiagnosed entity as a consequence of their subtle and protean clinical manifestations.

A series of 12 cases of primary facial nerve tumours is presented. The clinical features, diagnostic modalities and treatment are discussed in relation to a review of the literature.

Twenty-five cases suffering from rhinoscleroma were divided into two groups The first group consisted of 15 patients treated with rifampicin systemically The other group consisted of 10 patients treatcd locally with rifampicin in the form of ointment. Electron microscopic study of the pathological changes in the lesions showed that rifampicin is highly effective both systemically and locally in the treatment of rhinoscleroma.

In our series of 400 Chinese children with foreign body aspiration (FBA),343 cases were evaluated by fluoroscopy and/or plain chest X-rays before endoscopic removal of the foreign bodies. The majority of the foreign bodies (FBs) were organic (378/400, 94.5 per cent). The results showed that mainstem bronchial foreign bodies were diagnosed correctly in 68 per centof cases compared with 65 per cent correct diagnoses with segmental bronchial foreign bodies, but only 22 per cent correct diagnoses with tracheal, and 0 per cent correct diagnosis in those with laryngeal foreign bodies. Eighty per cent (32/40) of the children with laryngotracheal FBs had normal X-ray findings, whereas 67.7 per cent (205/303) of the children with bronchial FBs had abnormal chest X-ray findings. The most common positive radiological signs in the children with tracheobronchial FBs were obstructive emphysema (131/213, 62 per cent) and mediastinal shift (117/213, 55 percent). The incidence of major complications was related not only to the size of the foreign body and its location but also the duration since aspiration. The most common types of bronchial obstructions by airway FBs are discussed.

Technetium-99m (Tc99m)(v) Dimercaptosuccinic Acid (DMSA) is animaging agent which has been proposed as a scintigraphic marker for head and neck squamous cell carcinoma. Fifty-four patients were studied of whom 51 had a head and neck tumour. All patients were examined and then imaged using Tc99m(v) DMSA scintigraphy and computerized tomography.

Scintigraphy was less sensitive than clinical examination in the detection of patients with cancer, patients with primary tumours and patients with metastatic neck disease. CT was as sensitive and as accurate as clinical examination but more senstive than Tc99m(v) DMSA in detecting patients with cancer and with primary tumours. CT was more sensitive and more accurate than both clinical examination and Tc99m(v) DMSA scintigraphy in predicting which patients had metastatic neck disease.

Although Tc99m(v) DMSA is accumulated by squamous cell carcinoma, its inability to detect low volume disease and apparent low specificity means it has no role to play in the management of patients with head and neck squamous cell carcinoma.

We report 44 cases of monomorphic adenoma (MA) of the major salivary glands observed during the years 1979–1989. All of these tumours were reviewed and classified on the basis of the World Health Organisation (WHO) criteria. Histological type, site, sex and age were considered. 34 cases of adenolymphoma were observed, all of them located in the parotid glands; 10 MA without lymphoid stroma were located in both parotid and submandibular glands. Distinctive histological and clinico-pathological features of the latter group of tumours are discussed, as well as the diagnostic criteria in distinguishing these tumours from pleomorphic adenoma and adenoid-cystic carcinoma.

The term ‘tumefactive fibroinflammatory lesion’ has been usedto describe a fibrosclerosing disorder which has a locally destructive nature but is characterized by a benign histological appearance. We report five patients, over a five year period, with such a lesion.

The clinical behaviour and surgical findings suggest the lesion to be an invasive malignancy. However, the histological appearance of an admixtureof chronic inflammatory cells and fibrosis is consistent with a benign condition.

We recommend surgical excision of the lesion as the mainstay of treatment; other studies report the use of steroids and radiotherapy.

It has been suggested that children undergoing tonsillectomy would benefit from an intravenous infusion, to counteract the period of pre-operativefasting combined with the blood loss at operation.

A prospective study of 50 children undergoing tonsillectomy was undertaken. The children were randomly allocated into two groups, one to receive an infusion and a control group.

There were no significant differences between the two groups, although the children with an infusion had a longer mean post-operative stay.

There would seem to be no role for routine intravenous fluid replacement in children undergoing uncomplicated tonsillectomy.

Osteomas involving the middle ear and causing a functional disturbance are rare. We report a case of a patient with an osteoma arising from the lateral semicircular canal. The main symptom was vertigo and to halt this the defect of the canal was obliterated with a bone chip and fibrin glue after removal of the tumour.

Craniometaphysial dysplasia is a rare cause of conductive hearing loss. It is a genetic disorder of bone due to decreased osteoclastic activity inthe endosteal and periosteal regions of craniofacial and long bones. The characteristic temporal bone abnormalities are attic fixation, abnormallyshaped ossicles and obliterated foramina ovale. Computerised tomography is helpful in predicting operative findings; surgery should be reserved for those with a severe hearing loss.

We report the association of an auronasopharyngeal poiyp arising in a congenitally abnormal middle ear and Eustachian tube. Subsequently, ten years after removal of the polyp and insertion of a ventilation tube, there was recurrence of the polyp in association with cholesteatoma of the middle ear.

Diagnosing syndromes that include chronic sinusitis can expedite the management of both conditions. Yellow nail syndrome is usually described as the combination of yellow nails, lymphoedema and often respiratory manifestations such as chronic sinusitis, bronchiectasis and pleural effusions. The pathology responsible for the syndrome is believed to be lymphatic hypoplasia. Diagnosis of yellow nail syndrome is clinical not requiring anyspecialized tests. In the two cases described, the respiratory tract manifestations required the most active investigation and management. The significance of this syndrome to the otolaryngologist is discussed.

A rare developmental cyst within the tongue and submandibular triangle ofa male infant containing heterotopic gastric and intestinal epithelium (enterocystoma) is described and its derivation discussed. This cyst was ofsuch a size as to cause feeding difficulties and partial airway obstruction during sleep. Following C.T. scanning, total obstruction necessitated an emergency tracheostomy. Successful enucleation via a median labiomandibulotomy was performed without further complication and two years later there is no sign of recurrence.

Temporal arteritis (giant cell arteritis) is a disease of protean manifestation. A case which presented as a submandibular swelling is reported.

Two patients with carcinomata arising in pharyngeal pouches are reported. In one, the tumour was detected preoperatively by a contrast radiographicstudy. In the second the lesion was a carcinoma in situ. The English literature is reviewed with reference to these two unusual features.

Invasion of the skin of the neck by laryngeal carcinoma is relatively uncommon. Twelve cases of cancer of the larynx fungating through the cervical skin are presented. They mostly followed initial treatment by deep X-ray therapy or partial laryngectomy. A high tracheostomy was also considered to be a contributing cause for the occurrence of such a mishap. The management and follow-up of these patients is described.

We report a case in which a squamous cell carcinoma was found to have arisen from a delto-pectoral skin flap used in pharyngeal reconstruction. The flap had been forming a neo-pharynx for 24 years. No other signs of recurrent disease had developed in this period. This raises the possibility of tumour induction in heterotopic skin used for oropharyngeal reconstruction.

The combination of a parapharyngeal abscess and torticollis in an adult, due to a spastic contraction of the sterno-cleido-mastoid muscle is an extremely rare condition. We have recently been exposed to such a case, in which it was very difficult to make the diagnosis and where CT of the neck gave us the answers without any difficulty. The indication for CT at an early stage in unexplained neck infections is stressed.