Three-dimensional computer-aided surgery adds a ‘third-dimension’ to endoscopic sinus surgery. The images it provides have the potential to provide the surgeon with further information that might result in safer and more effective surgery with less surgical morbidity. The gold test, as yet untested, will be whether the technique leads to fewer revision procedures and complications as a result of more complete and safe initial surgery. Its greatest asset lies in reinforcing the surgeons’ estimate of an instrument’s position in a difficult anatomical area. It can augment the learning curve and enhance teaching and training in endoscopic sinus surgery but it is not a substitute for a thorough knowledge of paranasal sinus anatomy.

The author describes his personal reminiscences of the Royal National, Throat, Nose and Ear Hospital during World War II. Many of the colourful characters of this era arediscussed.

Eleven patients who had been surgically treated from 1988 to 1999 were retrospectively reviewed in order to evaluate the efficacy of ventilation tube insertion and mastoidectomy with, or without, mastoid obliteration for intractable middle-ear cholesterol granuloma. The mean age registered was 17.2 years at the time of surgical treatment. All cases were unilaterally affected. Five ears were treated with simple mastoidectomy coupled with the insertion of a ventilation tube, while six others had additional mastoid obliteration. The hearing prognosis was excellent with an improved post-operative hearing level of 16.5 dB (cf. pre-operative 37.7 dB). However, morphological prognosis revealed two ears had a residual perforated tympanic membrane without otorrhoea after displacement of the ventilation tube. Of the remaining nine ears with intact placement of the ventilation tube, five had dry ears while four had occasional otorrhoea. Although the morphological prognosis was incomplete, treatments involving at least aninsertion of a ventilation tube with thorough mastoidectomy were thought to be necessary.

The transmission of heat to the vestibule during revision stapes surgery with a piston in situ has been studied using a KTP laser in an in vitro model. A type K thermocouple was placed around the medial of each piston tested in a ‘vestibule’ filled with saline. The effect of laser hits on fluoroplastic, fluoroplastic-wire and stainless steel stapes prostheses was investigated. The effect of adding blood to the operative field, of introducing a vein graft to seal the stapedotomy and of vaporizing soft tissue in the oval window were also examined. Greater temperature rises occurred with stainless steel than with the other piston types and smaller rises occurred when there was a vein graft in situ. The maximum temperature rise recorded was 2.6°C. We conclude that the use of the KTP laser to clear soft tissue from the oval window is safe when operated at the power levels recommended by the manufacturer.

A labyrinthine fistula is a frequent complication of long-standing unsafe chronic suppurative otitis media. It is characterized by a slowly progressive erosion of the bony labyrinth. In this paper we present our observations regarding the diagnosis and management in 50 patients with unsafe chronic suppurative otitis media with labyrinthine fistula.

The weight distribution and postural sway was measured in diabetic subjectswith, and without, neuropathy, and then compared with age and sex matched non-diabetic subjectsusing a cheap and highly portable sway plate – SwayWeigh. The SwayWeigh was found to be very practical and the results obtained confirmed the increased postural sway in the absence of proprioceptive information in neuropathy subjects. The study shows that peripheral neuropathy increases the postural sway especially in the absence of visual clues but this did not result inpostural strategies causing significant limb load asymmetry.

Several problems have been observed when performing the classic endoscopic technique for voice restoration following laryngectomy. An easy and safe method is described for the insertion of a Provox® voice prosthesis using a Yankauer tonsil suction tube and an antrum trocar with an irrigation cannula.

We have earlier reported establishing a computerized database to audit functional outcomes in patients who underwent head and neck cancer treatment in Victoria, Australiaand attended speech pathology services from April 1997–April 1999. This paper presents the statistical analyses and results from this study.

Speech pathologists collected, prospectively, functional outcome data on 293 patients who underwent head and neck cancer treatment, and sent these for analysis to La Trobe University. Clinician and patient assessments of outcomes: speech, swallowing, activity, pain, employment, health, QOL status were made.

Initial data on 293 patients were collected and data on mortality and morbidity were compiled at three, six and 12 months post-treatment. Within twelve months, 74 patients had died. Three, six and/or 12-month follow-up data was available on 219 patients, with both clinician and patient assessments of status completed. The status forms are presented as appendices to this paper. Complete status forms on 179 patients at 12 months were obtained.

This clinical audit of functional outcomes represents the first study of this kind, collecting data from speech pathologists and patients in a multi-centre study of patients with head and neck cancer. We present data to demonstrate optimal recovery of function at six months, such that this may represent a good reference point for reporting and comparison of functional outcomes.

Pain and secondary haemorrhage are the commonest complications of adult tonsillectomy, occurring mostly in the community. This is a randomized, double-blind, placebo-controlled, prospective trial of the effect of perioperative amoxycillin on these complications. The incidence and severity of post-operative haemorrhage was measured. For the first 10 post-operative days patients provided a linear pain score, a record of GP visits, and their use of additional antibiotics and analgesics.

Of 95 patients considered: 23 suffered a secondary haemorrhage; 54 consulted their general practitioner (GP) because of pain; additional antibiotics were used by at least 31 and additional analgesics by at least 41. No significant differences were demonstrated between the active and placebo groups for any of these measures.

This study demonstrates that secondary haemorrhage is common after adult tonsillectomy. Post-operative pain remains a major problem requiring frequent GP consultations. There appears to be no justification for the routine use of perioperative antibiotics.

Laryngopharyngeal reflux (LPR), which is defined as the backflow of gastric contents into the upper aerodigestive tract, is a relatively common disorder. However, its diagnosis still poses many problems. Twenty-four-hour double-probe pH monitoring is currently the diagnostic test of choice, but it has many disadvantages. Thus, an empiric trial of antireflux therapy has been suggested as an alternative method for diagnosis. The purpose of this article is to evaluate the validity of this alternative method in the management of LPR. The study group consisted of 36 patients with symptoms and physical findings suggesting LPR. The control subjects were 23 healthy adults. Twenty-four-hour double-probe pH monitoring was performed both in the study group and the control group, and the results were compared. In addition, the symptoms and physical findings in the study group was scored by the modified reflux symptom index (MRSI) and reflux finding score (RFS) at four intervals: before the start of therapy and at the second, fourth and sixth months of the therapy. The results of the 24-hour double-probe pH monitoring showed no significant difference between the study and the control groups (p>0.05). In the study group, the MRSI before the therapy was 13.6±4.4. This index improved significantly to 4.3±1.9 at the second month; to 1.5±0.6 at the fourth month, and to 0.5±0.2 at the sixth month of the therapy (p<0.05). The RFS before the start of the therapy was 14.8±3.8; and it improved significantly to 7.7±3.8 at the second month; to 4.5±2.3 at the fourth month, and to 1.4±0.9 at the sixth month of the therapy (p<0.05). The significant improvement in the MRSI and the RFS during the course of proton pump inhibitor therapy relates the patients’ symptoms and physical findings to LPR. This implies the validity of the method, not only in the treatment of LPR, but in the diagnosis of this disorder, as well. Unfortunately, 24-hour double-probe pH monitoring has failed to differentiate LPR patients from healthy individuals.

One method for restoring the anterior floor of mouth defects resulting from T1 and especially T2 cancer excision involves the creation of a myomucosal island flap from the dorsal median portion of the tongue and transferring it as a transit flap to the floor of the mouth.

We are not the first to advocate this method. In this paper we present a previously unreported, slightly modified technique utilizing this tongue flap. The modification consists of a 90° twisting of the flap to achieve a more appropriate adaptation to the defect. In the case ofspreading carcinoma from the floor of the mouth to the central portion of the tongue, a similarparamedian one-sided tongue flap was created instead of a central island tongue flap. Our present experience consists of a small series of 12 patients. The procedures were successful in all patients. No remarkable disturbances of speech or deglutition were observed in any of the patients. There were two complications: one haematoma and one partial necrosis of the tip of the tongue. In our opinion, the reconstruction of the anterior floor of mouth defects using a central island tongue flap has not gained the popularity it deserves.

The first report of a patient with metastatic bronchogenic carcinoma of the skin surrounding the abutment of a bone anchored hearing aid (BAHA) is presented. Complications of bone anchored hearing implantation have been well documented to date. We present a 68-year-old lady who presented with an unusual skin lesion surrounding the abutment of her BAHA. This was the first presentation of her bronchogenic tumour.

We also review the literature regarding cutaneous metastasis and complications of BAHA.

Charcot-Marie-Tooth (CMT) disease or hereditary motor and sensory neuropathy (HMSN) is a relatively common neurological syndrome, which has seldom been associated with hearing dysfunction, particularly sudden sensorineural hearing loss (SNHL). Families with autosomal dominant, autosomal recessive and X-linked forms of inheritance have been described.

Sudden sensorineural hearing loss is a frustrating and frightening condition, especially if the hearing loss is bilateral. Regarding the site of the lesion, the evidence from the literature on HMSN suggests that either the VIIIth nerve or central auditory pathways are primarily involved in patients with hearing loss.

We report the first case in the English literature of a patient with Charcot-Marie-Tooth type II disease presenting bilateral SNHL in the course of his disease. The patient was hospitalized for 15 days, and undergoing treatment without any audiological improvement. Detailed clinical, audiological and laboratory examination was performed.

The aetiology and prognostic indicators of bilateral SNHL are discussed, as well as, the incidence of hearing loss in CMT patients.

Paranasal sinus mucoceles are benign, locally expansile cyst-like masses that are filled with mucus and lined with epithelium. Less than one per cent of them involve the maxillary sinus. Most of these are late complications of a Caldwell Luc procedure. A case is presented of a 31-year-old woman with a maxillary sinus mucocele who had undergone a Le Fort I maxillary advancement procedure 15 years previously – a complication never previously reported.

Primary non-Hodgkin’s lymphoma (NHL) of the sinonasal tract is uncommon. Morphologically and radiographically, sinonasal lymphomas are difficult to distinguish fromother malignant neoplasms or non-neoplastic processes. However, there is no general consensus about the need of routine histopathological examination for nasal polyps among otolaryngologists. We present a case of primary sinonasal NHL mimicking chronic hinosinusitis and debate the issue of routine histopathological examination. We suggest that all tissues removed from the sinonasal tract during surgery must be submitted for histopathological examination. Failure to do so may miss diagnosis and delay appropriate treatment.

Mucinoses constitute a diverse group of disorders that have in common the deposition of basophilic, finely granular and stringy material in the connective tissues of the dermis (known as dermal mucinoses); this also can occur in the hair follicles (follicular mucinoses) and finally in the epidermis (epithelial mucinoses). We present the clinical and histological findings of a case of focal mucinosis in a 76-year-old man who was otherwise fit and healthy. A literature review revealed a sparse number of such cases none of which was reported in the ENT literature. Focal cutaneous mucinosis is a benign condition but the authors believe it isof local and systemic interest to the Otolaryngologist as an addition to his or her armentariumof diagnoses.

Eosinophilic angiocentric fibrosis of the upper respiratory tract is a rare disorder of unknown aetiology. Despite characteristic histological findings, the aetiology and management of this lesion remain unclear. We describe a case of nasal eosinophilic angiocentric fibrosis and discuss possible demographic and aetiological patterns.

The authors report a first case of chronic motor axonal neuropathy involving ENT manifestations, in a 64-year-old male presenting with gait difficulties, effort dyspnoea and dysphonia. Eleven months after the first symptoms, he developed severe hypoventilation, limb weakness and bilateral vocal fold palsy and had to be intubated for respiratory failure. The diagnosis of chronic motor axonal neuropathy was suspected on clinical and electrophysiological grounds. The patient improved dramatically after a five-day course of 0.4 g/kg intravenous immunoglobulin. He is still being treated with methylprednisolone 0.5 mg/kg every other day and remains stable.

We conclude the bilateral vocal fold palsy may be associated with chronic motor axonal neuropathy and that the immunosuppressive treatment may be effective in such cases.

Melioidosis is an infectious disease caused by a saprophytic bacterium, Burkholderia pseudomallei. It is endemic to Southeast Asia and Northern Australia. The spectrum of melioidosis in humans varies from sub-clinical to overwhelming protean manifestations resembling other acute and chronic bacterial infections. Disseminated septicaemia melioidosis presenting as a masticator space infection is reported here. This is germane to those treating diabetic patients with deep neck infections living in, or having visited, areas endemic for B. pseudomallei.