To celebrate the 50th Anniversary of the establishment of the Midland Institute of Otology (MIO) a. meeting was held in the Belfry Hotel, West Midlands, 19–21 September 1997. The meeting comprised an excellent academic conference, social events and a golf tournament. A report on the academic conference has been published (Stansbie and Pahor, 1997).

The MIO has been established to further the cause of ENT in the Midlands and it has succeeded in its aim to a great extent. An historical overview of the Institute is of interest and would serve perhaps as a model for similar organizations, especially in the provinces.

The Institute was the brainchild of William Stirk Adams. He remained the President from the conception of the Institute till his death.It is befitting to present a biography of such a dedicated personality.

The traditional meatoplasty operations performed for chronic otitis externa, which has entered the ‘fibrotic’ phase, are often unsatisfactory because the results in terms of canal patency, hearing gain and patient satisfaction are variable. Although the use of laser in chronic ear surgery is well recognized, it has not been previously reported as a meatoplasty technique. Ten KTP laser meatoplasty operations were performed on eight patients with chronic otitis externa. This pilot study shows the technique to be effective, fast and with a high patient satisfaction rate in the short-term (mean follow-up period 9.3 months). The average increase in hearing thresholds was 24 dB HL. Significant patient benefit was obtained in at least six out of eight patients using the Belfast rule of thumb. The technique has many advantages over the traditional meatoplasty operations but the long-term results require evaluation.

The hybrid bone-substitute ionomeric cement is suitable for restoring the original anatomy of the posterior canal wall. During a four-year period the posterior meatal wall was rebuilt with ionomeric cement in 74 patients. The canal wall was totally rebuilt in38 patients, two-thirds rebuilt in 22 cases, and one-third rebuilt in14 cases. On the meatal side, the canal wall was covered by a musculo-periosteal (Palva) flap. In the majority of cases, the drum was closed with (cartilage)-perichondrium. Revisions were performed in 27 patients (due partially to cholesteatoma, and/or poor visualization of radical mastoidectomy cavities). The ears were non-infected at thetime of operation.

Permanent epithelialization of the bone replacement material was achieved in 57 cases, with secondary closure of a cutaneous defect of the meatal wall being required in six cases. The auditory canal wall had to be removed in 17 patients owing to deficient soft-tissue coverage, persistent inflammation, and/or partial adhesive processes with development of cholesteatoma. In terms of surgical technique, utilization of the material over a follow-up period of maximally seven years proved it to be a sophisticated procedure for reconstructing themeatal wall. Despite the finesse of the surgical technique employed, the overall failure rate of 31 per cent was inadmissibly high. Implantation of the material should therefore be restricted to middle ears with permanent ventilation and no trace of infection.

A prospective study of hearing loss in 120 cases with non-explosive blast injury of the ear, gathered over a six-year period, is presented. Thirty-three (27.5 per cent) patients had normal hearing, 57 (47.5 per cent) conductive hearing loss, 29 (24.2 per cent) mixed loss and one (0.8 per cent) had pure sensorineural loss. The severity of conductive hearing loss correlated with the size of the eardrum perforation; only a marginal difference was found between water and air pressure injuries, with respect to this type of hearing loss. Of all locations, perforations involving the posterior-inferior quadrant of the eardrum were associated with the largest air-bone gap. Audiometric assessment revealed that none of the patients suffered ossicular chain damage. Three patterns of sensorineural hearing loss were identified: a dip at a single frequency, two separate dips, and abnormality of bone conduction in several adjacent high frequencies. Involvement of several frequencies was associated with a more severe hearing loss than a dip in a single frequency. Healing of the perforation was always accompanied by closure of the air-bone gap, while the recovery of the sensorineural hearing loss was less favourable.

Six temporal bones and a brain tissue sample removed at autopsy from four patients with bilateral sudden hearing loss related to gastric adenocarcinoma were histologically studied. The pathological remains suggest that the sudden hearing loss of these patients may have occurred via one of two different mechanisms: (1) metastasis to the internal auditory meatus damaging the auditory nerve or (2) inner ear haemorrhage damaging Corti's organ. These two mechanisms may cause bilateral sudden deafness in patients with gastric adenocarcinoma.

Epstein-Barr virus (EBV) is associated with nasopharyngeal carcinoma (NPC). The BHRF1 EBV protein is expressed at high levels in productively infected cells and certain latently infected cells. In order to investigate the effect of expression of BHRF1 on the biological behaviour of NPC cells, we constructed the BHRF1 high expression vector and transfected it into the NPC cell line, CNE2. Then, the alteration of proliferation and apoptotic rates in the cells were tested before and after camptothecin treatment. After treatment by camptothecin, BHRF1-CNE2 cells could constantly and slowly proliferate and its apoptotic rate was less than in control groups, and the number of cells in the G phase decreased and in the S phase increased. So, it suggests that BHRF1 expression can enhance the resistibility of CNE2 cells to DNA damaging agents that cause apoptosis.

A questionnaire was sent to consultant Otolaryngologists (483) throughout the UK to identify any mortality associated with uvulopalatoplasty and other forms of palatoplasties for snoring and/or obstructive sleep apnoea. The response rate was 76.8 per cent (371). Six intra- and post-operative deaths were reported and four were known to have obstructive sleep apnoea. Life-threatening morbidity occurred in at least seven patients (three known apnoeic), two required immediate tracheostomy and two were managed in the intensive care unit. This suggests that the apnoeic patients undergoing palatoplasties experienced significant mortality and morbidity. Pre-operative sleep study should be performed in all snoring patients to identify the apnoeic subgroup. Continuous positive airway pressure, management of excessive obesity, elective tracheostomy and other strategies should be first considered before palatoplasties in these patients.

Pierre Robin sequence (PRS) presents in the neonatal period with upper airway obstruction and feeding difficulties. Infants with pronounced micrognathia may fail to thrive because of chronic airway obstruction, or experience severe respiratory distress. This is potentially fatal and surgical intervention in these cases is necessary. We present our series of cases with severe PRS requiring surgical relief of their airway obstruction, and the reasons for preferring tracheostomy over glossopexy.

A prospective study into the aetiology of acute food bolus obstruction (AFBO) was carried out on 17 consecutive patients who presented with this complaint. There were nine males and eight females. Twelve patients (71 per cent) had symptoms of oesophageal disease and 10 patients (59 per cent) had prior food bolus obstruction. Investigations included endoscopy, barium swallow, oesophageal pH and manometry studies. Evidence of oesophageal pathology was found in 12/14 (86 per cent) of patients investigated. No patients had malignancy and the most common abnormality, gastroesophageal reflux (GOR) was found in eight out of 14 (57 per cent) of cases. Oesophageal dysmotility was seen in five out of 12 (42 per cent) patients who had manometric studies.

With such a high incidence of recurrence of AFBO, we suggest that patients with this condition be investigated to exclude malignancy and to identify benign oesophageal pathology using techniques such as oesophageal pH and manometry. Appropriate treatment of oesophageal disease may help prevent recurrence of this distressing condition.

We present a case report which describes a rare cause of a common clinical problem; eustachian tube dysfunction. A seven-year-old child presented with a history of chronic draining ears, despite rigorous medical therapy and multiple ventilation tubes. At myringotomy a mass was noted in the middle ear, and she was taken to the operating room for exploration. The patient was found to have a pedunculated lipoma arising from the anterior medial aspect of the middle-ear cleft producing intermittent obstruction of the eustachian tube orifice. This case represents the fourth case of a middle-ear lipoma in the world literature. We present a review of the literature and an exploration of possible aetiologies of this unusual entity in the differential diagnosis of eustachian tube dysfunction.

Perilymph fistulae have been described for over 30 years and yet there are no universally accepted diagnostic criteria or treatment regimes for them. This paper describes an unusual case of a presumed traumatic perilymph fistula and discusses its treatment and prognosis in relation to previous studies.

A rare case of invasive aspergillosis of the paranasal sinuses in a previously healthy individual is presented. The disease caused severe complications and proved fatal. Classification, aetiology and presentation of sinus aspergillosis are discussed. Early diagnosis and management is stressed to avoid the high incidence of morbidity and mortality.

Neurogenic tumours of the larynx are unusual, with approximately 115 cases reported in the literature to date. Most of these lesions are benign, solitary submucosal nodules which present with hoarseness and are amenable to surgical resection. We present a case of a large pedunculated schwannoma arising in the aryepiglottic fold associated with sudden asphyxial death in an otherwise healthy young female.

Acute blunt laryngeal trauma can be a life-threatening event and often poses a difficult airway management problem. Patients may be unable to supply important anemnestic facts because of aphonia or intubation as a result of their injury. Therefore the immediate recognition and appropriate initial assessment and treatment are vital for a successful outcome. The first step is assuring an appropriate airway, either by careful intubation or temporary tracheotomy. An assessment of potential vascular and oesophageal injuries must be undertaken. The use of computerized tomography (CT) with contrast material is especially useful in identifying and localizing fhe damage caused by blunt neck injuries. Laryngeal fractures, air in the soft tissues and the extravasation of contrast material in the neck are all helpful in assessing the injuries before surgical intervention. Immediate initial surgery is aimed at stabilizing the cartilaginous framework and repairing the mucosa. We present a case of severe laryngeal injury caused by blunt trauma to the neck; our evaluation, treatment and the outcome.

A rare case of pleomorphic adenoma of the base of the tongue with a relevant review of literature is reported.

True dermoid cysts of the oral cavity are rare, usually presenting as midline swellings in the floor of the mouth and occasionally elsewhere in the oral cavity. This report describes the diagnosis and management of a congenital dermoid cyst of the lateral aspect of the body of the tongue in a 10-year-old girl. The theories of the pathogenesis of this cyst during embryogenesis of the tongue are also reviewed.

Acute torticollis may result from an inflammatory process irritating the cervical muscles. In children there is often an association between acute torticollis and retropharyngeal cellulitis/abscess.

Over six weeks, two children with acute torticollis presented to our Department. Both children were found to have retropharyngeal cellulitis/abscess. The problem of differentiating between the non-suppurative and the suppurative phases of the disease process is discussed.

Adenoid cystic carcinoma of the parotid gland often recurs locally, or metastases develop, after initial treatment with surgery and radiotherapy. We report a patient with an inoperable local recurrence of previously irradiated adenoid cystic carcinoma, who was treated with tamoxifen, an oestrogen receptor antagonist. After 18 months of treatment with tamoxifen, MRI showed a partial response, and further clinical progression of the disease was halted.

Eight patients with cervical pain were examined. The only positive finding was an impressive tenderness over the thyroid cartilage (in seven patients) or over the area of the insertion of the sternocleidomastoid muscle to the mastoid process (in one patient). The diagnosis of thyroid cartilage syndrome and mastoid process syndrome were suggested and the patients were treated with oral and topical non-steroidal anti-inflammatorydrugs (NSAIDs) which reduced the symptoms. These syndromes are rare. The thyroid cartilage syndrome has been previously reported only once in the literature and this is the firstreport on the mastoid process syndrome. These syndromes, although rare, should be included in the list of causes for cervical pain and better recognition of the syndromes will save patients from undergoing unnecessary investigation and inappropriate treatment.