In his best poems, the Renaissance poet Sabo Bobljević Glušac emphasizes his hearing impairment, placing his deafness at the centre of attention. These works are not only a poignant expression of an individual artist's suffering, but they may also add to our understanding of the situation of deaf persons. This self-reflection can be seen as a detail that will enhance our ability to communicate with deaf people in order not only to help them hear us, but also to make us hear them as well.

Isolated congenital anomalies of the ossicles are rare. The majority of cases of congenital conductive hearing loss secondary to middle-ear anomalies have other associated defects, such as atresia, microtia and craniofacial deformities.

We present a rare case of isolated congenital stapes suprastructure fixation, where a monocrural stapes with a mobile footplate was attached to the promontory by bony synostosis. There was no stapedius muscle nor pyramidal process. The incus and malleus were of normal configuration. Mobilization of the stapes from the promontory resulted in improvement in hearing. We believe this is the first reported case of such an abnormality. A review of the world literature of isolated stapes suprastructure ankylosis and the classifications of minor congenital anomalies are discussed.

This audit report details early post-operative complications following surgery for chronic otitis media. One hundred and forty-five cases were assessed. There were no facial nerve palsies, a bone conduction threshold elevation occurred in 4.6 per cent of cases. A wound infection occurred in six per cent of cases as did BIPP allergy. Twenty-six per cent of patients reported symptoms consistent with chorda tympani trauma. Short-lived symptoms of jaw discomfort were reported by 46 per cent of patients and imbalance or vertigo by 10 per cent of patients. The findings are compared with other published reports of complications following ear surgery.

The ossified cochlea, although rare, represents a challenge for cochlear implantation. While it is no longer considered an absolute contra-indication to implantation, insertion may be technically difficult and the results may be suboptimal. Techniques which have been employed are reviewed. The new Digisonic™ multi-array implant, which was designed specifically for use in the ossified cochlea is described, along with the technique used for its insertion.

In the first patient to be implanted with this new implant, all electrodes lie within the cochlea and are functional. The new Digisonic™ multi-array implant may have advantages over other solutions for the ossified cochlea.

As in radiation-induced cancer, post-irradiation sudden deafness (PISD) is defined as sudden onset deafness in patients post-irradiation. Fifteen nasopharyngeal carcinoma (NPC) patients with PISD were enrolled in this study. The mean interval from the completion of irradiation to the occurrence of PISD was 12 years. Seven had total deafness, seven had profound hearing loss, and one had moderate hearing loss. Nine out of 15 (60 per cent) patients experienced hearing recovery within three months after treatment. In conclusion, PISD is a late complication in NPC patients post-irradiation. The causative mechanism is theorized as vascular insufficiency.

The improved cost-effectiveness of gadolinium-enhanced magnetic resonance imaging (MRIg) as a diagnostic tool for vestibular schwannoma has resulted in smaller tumours being diagnosed. There has been a change in the clinical presentation of these tumours and up to four per cent may present with unilateral tinnitus. The limitation of auditory brain stem response (ABR) as a screening tool that detects small tumours is recognized and there is a strong argument for using MRIg as the initial investigation.

Various screening guidelines have been proposed, some include submitting patients with unilateral tinnitus for MRIg. This report describes the findings in a group of 174 patients presenting with unilateral tinnitus who underwent MRIg as part of a guideline-directed screen to exclude vestibular schwannoma. Five patients had a cause for their tinnitus diagnosed, one a vestibular schwannoma. Two had intracranial aneurysms and another three had pathology revealed that merited onward referral. A further nine patients had incidental findings that neither accounted for their symptoms nor needed further investigation or referral.

The rationale for screening these patients with MRIg is discussed.

Nasal septal perforation may present with various symptoms. Perforations may be surgically closed or managed by obturation, inserting a prosthesis. We used a silicon septal button in the management of nasal septal perforation. In the follow-up period, although the insertion of the nasal septal button alleviated epistaxis, whistling during inspiration, and nasal obstruction, it could not control the production of crusting around the margin of the button.

The bacteriology of maxillary sinuses with normal endoscopic findings is reported in this study. When transantral sinoscopy was used to examine the maxillary sinuses, the whole maxillary sinus was inspected with different-angle endoscopes. If no lesion was seen over the whole maxillary sinus mucosa, no secretion existed in the maxillary sinus cavity, and the maxillary sinus ostium was wide open, the maxillary sinus was considered endoscopically normal. The bacteriology of these endoscopically normal maxillary sinuses was studied by passing cotton-tipped sticks through the cannula to collect swab specimens. In some cases, a biopsy forceps was also passed to obtain mucosal specimens. The specimens were sent to the laboratory for aerobic and anaerobic cultures. Between July 1990 and May 1998, 83 swab and 31 mucosal specimens were collected from 69 patients who had not taken any antibiotic within 10 days before endoscopy. The culture rates were 62.3 per cent (35/53) from swab specimens and 57.1 per cent (eight out of 14) from mucosal specimens in patients with the diagnosis of chronic paranasal sinusitis, and were 46.7 per cent (14/30) from swab specimens and 41. 2 per cent (seven out of 17) from mucosal specimens in patients without this diagnosis. This study shows that endoscopically normal maxillary sinuses are not sterile.

The purpose of this study was to examine the effect of pre-treatment anaemia on tumour recurrence and survival in patients treated with primary radiotherapy for early squamous cell carcinoma of the larynx. A retrospective analysis of 117 patients with previously untreated T1N0M0 and T2N0M0 squamous cell carcinoma of the larynx was carried out. Patients were considered anaemic if their pre-treatment haemoglobin levels were below 13 g/dl in males and 11.5 g/dl in females. The influence of pre-treatment haemoglobin levels on local control and survival were evaluated using Cox proportional hazards regression models.

Two- and five-year local-regional control estimates for anaemic patients were 58 per cent and 53 per cent respectively while patients with normal haemoglobin levels had two and five-year local-regional control rates of 90 per cent and 81 per cent respectively (p = 0.002). Multivariate Cox regression analysis showed pre-treatment haemoglobin significantly influencing recurrence-free survival (p = 0.0094).

Patients with a low haemoglobin level prior to radiation therapy suffered higher levels of local-regional failure.

The use of the buccal fat (BFP) and palatal rotating flaps for the closure of oro-antral communication and reconstruction of palatal defects was compared clinically. The BFP proved to be consistently successful in closing oro-antral fistulae and palatal defects resulting from tumour resection, preserving the normal anatomical architecture of the oral mucosa. No denuded area requiring secondary granulation was required as in the case of palatal flaps. In addition, no facial disfigurement was observed on the operated side.

BFP is considered a reliable, convenient method for closure of palatal defects and closure of oro-antral communication. It can also be considered as a reliable back-up procedure in the event of failure of other techniques.

Nasogastric tube placement is desirable for the short-term administration of calories when oral feeding is not possible. Enteral nutrition is superior to parenteral nutrition. In some patients this method of feeding is impossible because of repeated failure of nasogastric tube placement, necessitating either general anaesthesia for enteral access, or total parenteral nutrition. We describe a new method for nasogastric tube placement aided by a fibre-optic nasendoscope which has resulted in the successful placement of over 20 nasogastric tubes in our unit and the avoidance of more invasive methods of establishing nutrition with their associated complications.

Branchio-oto-renal syndrome is a rare autosomal dominant condition characterized by hearing loss, branchial arch abnormalities and renal tract malformations. We present the first reported case of branchio-oto-renal syndrome associated with bilateral congenital cholesteatoma and ossicular chain abnormalities. The pathogenesis of this syndrome is described and the literature is reviewed.

Septorhinoplasty is a very common operation in otolaryngological practice. We report the second case of a carotico-cavernous fistula following septorhinoplasty. This case presented with very severe epistaxis before the appearance of the typical pulsating exophthalmos, ophthalmoplegia, headache and engorged veins on the right side of the face. Our case was treated by endovascular thrombosis with electrolytically detachable coils.

Tracheo-oesophageal puncture for voice restoration is a well-established technique post-laryngectomy. A number of complications can occur with the creation of a tracheo-oesophageal fistula (TOF) and in the subsequent management of the patient with an indwelling voice rehabilitation system.

This article is the first to report the use of Hylaform®, a colourless viscoelastic gel, to treat an intractable case of leakage around a Provox® 2 voice prosthesis. The procedure which required no anaesthesia resulted in no further leak around the valve to the present day, now more than four weeks post-viscoaugmentation.

A case is reported in which an inhaled sewing needle, stuck fast in the trachea, became displaced through the tracheal wall during attempted removal via flexible bronchoscopy. The inherent risks and pitfalls of this procedure are highlighted.

Tracheo-bronchial foreign bodies can be very difficult to remove. This may be related to the location and type of foreign body, the experience of the bronchoscopist and the availability of appropriate instruments.

We report a case of an uncommon foreign body in an unusual location in an adolescent in whom conventional attempts to remove it failed. The foreign body was eventually recovered using a flexible bronchoscope and an intravascular wire loop snare under fluoroscopic control. The patient was saved from thoracotomy and possible lobectomy.

To our knowledge, this combined fluoroscopic and endoscopic approach for the removal of a difficult tracheobronchial foreign body is the first reported case in the literature.

The stylohyoid ligament extends from the styloid process to the hyoid bone. For an unknown reason it occasionally ossifies and forms a solid structure which can break because of trauma or even spontaneously. Symptoms of the fracture may mimic tumours, foreign bodies, infections or neuralgia. In our cases a spontaneous fracture of totally ossified stylohyoid ligaments presented as a painful neck swelling. The diagnosis was achieved by an ortopantomographic radiograph. In both cases the healing was spontaneous and complete.

The first case of traumatic myositis ossificans (TMO) involving a strap muscle of the neck is reported. TMO typically presents with an unresolved mass following trauma or surgery, requiring differentiation from other soft tissue and bone neoplasms. Opacification may be present on soft tissue X-rays. Computed tomography (CT) scan may demonstrate a characteristic zoning phenomenon to establish the diagnosis. The disorder is frequently self-limiting but surgery may be required for persistent symptoms.

We present a rare case of unilateral phlebectasia of the anterior jugular vein in a 56-year-old male patient whose complaint is a neck swelling that appears during talking. Although in this age group the most common cause of such a mass in the anterior aspect of the neck increasing in size during any type of straining or Valsalva manoeuvre is a laryngocele, phlebectasia of the anterior jugular vein should be considered in the differential diagnosis. Doppler ultrasound and computed tomography are the most useful and non-invasive methods to use for the investigation. Treatment should be conservative.

Ollier's disease and Maffucci's syndrome are similar multiple enchondromatous conditions. Other co-existing pathologies, particularly other primary malignancies, have been described sporadically in both conditions but more so in Maffucci's syndrome. Maffucci's syndrome is distinguished from Ollier's disease by the presence of haemangiomas in the former. In this report, a patient believed to have Ollier's disease for 44 years was subsequently found to have large splenic haemangiomas on magnetic resonance imaging (MRI). In the light of this, we recommend that any patient diagnosed with Ollier's disease to have total body MRI to search for haemangiomas that will alter the diagnosis to Maffucci's syndrome and hence the prognosis. MRI also screens for the presence of other associated malignancies.