The long-term results of 63 total ossicular chain reconstructions using autografts is presented. The follow-up period ranged from 18 months to 18 years with an average of 8.5 years. The primary aims of the study were firstly to assess the long-term success rate and to find out if there were any hitherto unknown causes of bone graft failure. In the event, it was found that the recently described anatomical variation of the oval window viz., the deep oval window, was the prime cause of failure in 32 per cent of unsuccessful cases. Some measures to help to mitigate this problem, are suggested. The result were assessed on the basis of:

1. A minimum gain of 20 dB HL in air conduction (Technical success). The success rate was 55.5 per cent.

2. Patients benefited using Smyth and Patterson's criteria in conjunction with the Glasgow Benefit Plot; 54 percent of the patients benefited significantly.

One hundred and sixty-five cases of different kind of ossiculoplasty in patients suffering from chronic middle ear disease were performed at the ENT department of Papanikolaou Hospital in Thessaloniki, Greece, during the years 1988–1990. There were 40 cases of incus transposition, 47 cases in which polyethylene TORPs and PORPs were used and 77 cases of hydroxylapatite prostheses (41 TORPs and 37 double notch PORPs). Hearing success was defined as a post-operative air-bone gap of <20dB. According to this criterion 74 percent of the incus transposition cases were successful, 61 percent of the polyethylene TORPs, 65 percent of the hydroxylapatite TORPs, 40 percent of the polyethylene TORPs, and 89 percent of the double notch hydroxylpatite PORPs. It is obvious that ceramic PORPs produced the best results, while there was no statistical difference, regarding the hearing improvement, among the different kinds of TORPs which were used. Extrusion rate and other kinds of complications are also discussed, as well as a case of severely damaged ceramic TORP, within two years due to middle ear infection.

Seventy patients with nasal polyps were studied. Forty-seven of these had pre-operative sinusradiographs and all seventy patients had antral washouts at the time of nasal polypectomy. One hundred and seventeen antral aspirates were sent for culture and microscopy. The naked eyeappearance of aspirates were turbid in 34 patients. Bacteria were cultured from 15 of the specimens in 10 patients.

It was concluded that antral washout should be recommended in all patients who have nasal polypectomy and that there is no need for sinus radiographs in those patients who have uncomplicated nasal polyps.

Rhinoscleroma is a chronic specific granulomatous inflammatory condition that has an affinityto the mucosa of the upper respiratory tract. Involvement of maxillary antrum is said to be very uncommon. In the present study antroscopy was performed in 20 patients with rhinoscleroma to find out the type, nature and site of the lesion in the maxillary antrum. The maxillary antrum was involved in 60 per cent of cases with rhinoscleroma. The lesions occurred in the form of atrophic changes, granuloma, and the fibrotic thick healed stage. The anterior–inferior part and medial wall of the antrum are found to be more commonly affected. It is suggested that involvement of maxillary antrum in scleroma may act as a reservoir of infection and such patients may therefore take a longer time to respond to antibiotic therapy.

In 1980, Bhargava et al. reported a new treatment of allergic and vasomotor rhinitis by the local application of 15 percent silver nitrate. The results of further studies of the treatment by using different concentrations of silver nitrate ranging from 5 percent to 25 percent and normal saline as placebo are presented here; 15 percent has been found to be the most effective concentration giving successful results in 75.7 per cent of cases. It is applied to the anterior portion of both inferior turbinates and the anterior part of the nasal septum once aweek on five occasions.

Best relief was obtained from the most annoying symptoms of sneezing and rhinorrhoea. Asthma was controlled in 50 percent of such patients who had attacks of allergic rhinitis followed by asthma.

For this widely prevalent disease, the treatment was found to be simple, easy and useful, with negligible side-effects.

The maxillary sinuses of 40 patients suffering from primary atrophic rhinitis (ozaena) were studied radiologically, antroscopically and histopathologically. Sixty percent of the patients showed thick bony walls and a small cavity of the maxillary sinus on X-ray and on antroscopy. On the other hand, 25 percent of the cases revealed signs of infection including mucopurulent secretion on antroscopy associated with corresponding histopathological changes. It is concluded that poor pneumatization of the antrum plays a more important role in the pathogenesis of ozaena than infection.

Most patients have no response to injectable collagen or silicone, but some cases may have positive or ‘undersea’(= clinically negative but immunologically positive) response to collagen. From the results of the Macrophage migration inhibition test, the relative immunogenicity was augmented most when we used implants with the following combination. The firstimmunization was collagen and the second one was collagen with silicone.

The augmented antigenicity might be enough to cause an allergic reaction to the patients who had no response to each implant alone. The purpose of this article is to warn of the potential hazard of injection.

The use of flexible nasopharyngoscopy with biopsy forceps for the removal of fish bones found in the oropharynx and hypopharynx is described. One hundred and sixty-eight patients with ingested fish bones in the upper aero-digestive tract were studied over a 12-month period. Of these, 73 percent were removed per-orally, or by indirect laryngoscopy. Fifteen percent were removed using the fibreoptic nasopharyngoscope. Twelve percent required a general anaesthetic and rigid oesophagoscopy for removal of fish bones at or below the level of the cricopharyngeus muscle. The technique has proven to be quick, well tolerated and low in morbidity. It is invaluable in patients in whom indirect laryngoscopy is unsatisfactory.

Twenty-four patients with squamous cell carcinoma of the tongue were treated with 5,000 cGy to 6,500 cGy pre-operative irradiation. Surgery usually consisted of resection of the tongue, possibly the floor of mouth, and modified or radical neck dissection. Musculocutaneous flaps for reconstruction were used in three cases and a forearm flap in one case. Despite the high radiation dose, no major difficulties were encountered at surgery or during the convalescence period, except for one osteoradionecrosis of the mandible, which was successfully treated by microvascular osteomyocutaneous grafting. Residual carcinoma was seen on histological examination of the excised tissue in 9 out of 18 (50 percent) patients who received ≥6,000 cGy, and in 4 out of 6 (67 percent) patients who received about 5,000 cGy tumour dose. The 2-year crude survival rate was 65 percent. The data suggest that high dose pre-operative irradiation is feasible and does not compromise surgical treatment.

A retrospective study of the complications of treatment with the carbon dioxide (CO2) laser of 17 patients diagnosed to be suffering from recurrent laryngeal papillomatosis is presented. No immediate complications occurred except one case of laryngospasm and failure to intubate during anaesthesia leading to hypoxic encephalopathy. Three patients were completely free from disease and complications. Another patient was free from laryngeal lesions but developed a papilloma in the right tonsillar pillar. Five other patients showed one or more multiple sites of involvement in addition to the larynx. Laryngeal scarring developed in ten patients. Six patients (35.29 percent) developed scarring as anterior glottic webs while in two scarring (11.7 percent) occurred as posterior glottic webs. One developed scarring in the supraglottic region. The remaining one had scarring in both the glottic and supraglottic regions. One patient developed tracheal scarring necessitating laryngo-tracheal separation. Two patients were psychologically disturbed during treatment requiring psychiatric consultation and therapy.

The ENT specialist's experience of emergencies is usually influenced by a process of prior selection in the GP surgery or in a general Casualty Department. A survey of 1,000 consecutive patients presenting to a 24 hour open access ENT Casualty service is presented. For a variety of reasons, over half of these patients had never sought their G.P.'s advice for their ENT complaint but preferred the hospital service. The value of even a brief exposure to ENT casualty work for GP trainees is demonstrated.

A case of difficult diagnostic rigid bronchoscopy is described. However, flexible fibrescopy could be easily performed through a laryngeal mask airway despite complete lack of experience by the operator. Excellent visualization of the larynx and bronchial tree with minimal haemodynamic disturbance accompanied the technique.

Tracheostomy self care at home can be a problem for some patients. The Nottingham System attributes a competence ratio to each patient. Those liable to develop problems can be identified early and the appropriate support provided. The Nottingham System is described.

Darier's disease is a hereditary dermatological condition characterized by crusted papules distributed over the seborrhoeic areas of the trunk and head. A case of Darier's disease presenting to the Otolaryngology department because of severe involvement of the pinna is reported. The typical histological appearances are described and treatment discussed.

Ceruminous glands should no longer be regarded as purely apocrine glands, but as apoeccrine glands with both apocrine and eccrine modes of secretion. We present two cases of pleomorphic adenoma of ceruminous glands, among the rarest of such tumours. The use of such terms as ‘ceruminoma’ and ‘hidradenoma’ should finally be abandoned, and ‘ceruminous gland tumour’ used instead as a generic term. Classification should be based on Wetli's prototype (adenoma, pleomorphic adenoma, adenoid cystic carcinoma and adenocarcinoma), with the addition of benign eccrine cylindroma and syringocystadenoma papilliferum; the inclusion of mucoepidermoid carcinoma should await full validation. Wide local excision is necessary for all tumours, with only follow-up for histologically benign neoplasms. Malignant tumours need early aggressive surgery and radiotherapy. If marginal invasion cannot be assessed histologically, then adenoma and adenocarcinoma cannot be distinguished and we suggest that the tumour be reported as ‘of uncertain malignant potential’. Long-term studies are needed to confirm or refute the view that all ceruminous gland tumours are potentially malignant.

We report the first known cases of Fusariosis of maxillary sinus with granuloma and oro-antral fistula in two immunocompetent hosts. Fusarium solani was demonstrated in the direct microscopic examination and isolated in heavy growth from the biopsy materials. Both these patients were successfully treated with oral ketoconazole (200 mg daily) for three weeks followed by a Caldwell-Luc operation. Ketoconazole was continued for two months post-operatively.

We describe a case of myasthenia gravis in a 46-year-old man presenting as acute stridor with bilateral abductor paralysis of the vocal folds. Prompt diagnosis and medical treatment with pyridostigmine avoided the need for tracheostomy. It is important to remember the possibility of myasthenia gravis in cases of stridor due to bilateral vocal fold paralysis, since effective medical treatment is available.

We present a case of virus-associated haemophagocytic syndrome following Epstein-Barr virus infection in which a fulminant pseudomonal supraglottitis developed. Increasingly, unusual pathogens have been found in immunocompromised patients. This is the first reported case of pseudomonal supraglottitis.