To highlight the difficulty in making a correct diagnosis of benign schwannoma in the paranasal region, to raise awareness of this rare condition, and to suggest the most appropriate treatment.

Retrieval of cases retrospectively from archives of the histopathology department of a major UK cancer centre with central review of all cases.

Five cases were identified since 1990 and clinical and pathological features are summarised. Median follow up of patients was 8.1 years. Radiological appearances of local bone invasion and histological features of tumour unencapsulation and hypercellularity could give the mistaken impression of malignant disease and lead to unnecessary over-treatment.

Central pathological review and clinical awareness is required. Although local recurrence can occur, the prognosis is excellent. The treatment of choice is local excision. Radiotherapy can be considered, but in most cases it would incur unnecessary morbidity.

Olfaction studies in the institution of Department of Otorhinolaryngology at Leicester Royal Infirmary have detected a previously unreported, variable phenomenon – ‘superosmia’ – in which subjects' olfaction threshold concentrations are up to 100 000 smaller than the average value.

The aim of this report is to define and quantify this phenomenon.

Two hundred and thirty subjects, who had been screened for active nasal pathology (age range 20–60 years), underwent individual olfactory threshold tests for phenylethyl alcohol or eucalyptol, using a computer-driven olfactometer in a controlled laboratory setting. Some tests were single tests and others were repeated on a small cohort.

Two per cent of subjects demonstrated the superosmic phenomenon on single testing, and 10 per cent demonstrated this phenomenon on variable occasions during repeated testing. The superosmic phenomenon was defined by: (1) confident olfactory perception of a threshold at least equal to if not greater than three threshold levels below the subject's average threshold; (2) repeated perception of the odour at this level for at least 10 responses (1:1024 probability of chance finding); and (3) (where time permitted) a sudden, rapid loss of superosmia.

Superosmia is a distinct phenomenon, the stimulus or mechanism of which is currently the subject of further research. The enhancement of olfactory ability may be possible through activation of an accessory pathway or modulation of the existing olfactory apparatus.

Traumatic optic neuropathy can be treated by various methods including steroids and surgical decompression. Endoscopic optic nerve decompression has been suggested to be effective in treating this condition. The aim of this study was to assess the outcome of treating traumatic optic neuropathy with steroids and endoscopic surgical decompression.

Two hundred and thirty-seven patients with traumatic optic neuropathy were treated with steroids; 176 also consented to endoscopic optic nerve decompression.

The total vision improvement rate was 55 per cent in the 176 patients treated with both steroids and endoscopic optic nerve decompression, compared with 51 per cent in the 61 patients treated with steroids alone; this difference was not statistically significant (p > 0.05). Treatment with steroids plus endoscopic optic nerve decompression resulted in a significantly greater vision improvement in patients with gradual vision loss, compared with those with immediate blindness (68 vs 42 per cent, respectively). Early surgery (within one week) was an important prognostic factor for vision recovery, compared with more delayed surgical treatment (associated vision improvement rates were 60 and 31 per cent, respectively).

Endoscopic optic nerve decompression is a minimally invasive, safe and efficient treatment for traumatic optic neuropathy. Used in combination with steroids, it provides effective rescue for some patients suffering visual loss. It should be undertaken as soon as possible.

Functional endoscopic sinus surgery is a common adjunct to medical therapy in cases of chronic rhinosinusitis and nasal polyposis.

The objective of this study was to assess patients' quality of life up to two years after endoscopic sinus surgery.

Fifty consecutive patients attending a rhinology clinic filled in the Glasgow benefit inventory. The patients were divided into three groups according to the time period elapsed since surgery (i.e. six months, 12 months or up to two years).

The results showed that, generally, the Glasgow benefit inventory scores indicated a benefit from the procedure. Overall, surgery led to statistically significant improvements in both total and general scores (p < 0.05). Comparison of endoscopic sinus surgery with nasal polypectomy (plus endoscopic sinus surgery) indicated a greater benefit for polyp disease. No statistical difference was observed between the scores for females vs males or for various post-operative follow-up periods.

To describe a series of five patients with isolated fracture of the manubrium of the malleus.

Retrospective case series.

Five patients aged 44–64 years with isolated fracture of the manubrium who presented to our institution over a five-year period (2000–2005).

All patients presented with a history of digitally manipulating the external auditory canal, leading to the manubrial fracture, which we presume was due to a suction-type mechanism. Otomicroscopy often revealed a break in the smooth contour of the manubrium. All patients had air–bone gaps on audiometry, especially at higher frequencies. Tympanometry showed hypermobility of the tympanic membrane in four patients who were tested. Laser-Doppler vibrometry revealed increased umbo velocity in four out of five patients. Four patients were treated conservatively. One patient underwent exploratory tympanotomy with successful ossiculoplasty.

Isolated fracture of the manubrium is a rare condition which may present as sudden-onset hearing loss after digital manipulation of the external auditory canal. The diagnosis can be made on the basis of otomicroscopy, audiometry, tympanometry and laser-Doppler vibrometry. Conservative treatment is often successful.

To determine the incidence of complications following temperature-controlled radiofrequency treatment of the soft palate, uvula and tongue base.

Retrospective study.

We included all patients who had received temperature-controlled radiofrequency treatment of the soft palate, uvula and tongue base, for sleep-disordered breathing, over a four-year period in a tertiary hospital. Patients' medical records were systematically reviewed for radiofrequency treatment parameters and complications.

Complication rates.

Seventy-six patients had been treated, with a total of 127 treatment sessions and 544 lesions to the palate, uvula and tongue base. The incidences of minor and moderate complications were, respectively, 2.6 per cent (14/544 lesions) and 0.4 per cent (2/544 treatment lesions), being 3.0 per cent (16/544 lesions) overall. Subdividing by anatomical region, the incidences of minor and moderate complications following palatal and uvula radiofrequency treatment were, respectively, 3.1 per cent (14/446 lesions) and 0 per cent, and those following tongue base treatment were, respectively, 0 per cent and 2.0 per cent (2/98 lesions). The incidence of minor complications following soft palate and uvula treatment, per treatment session, was 10.9 per cent. The incidence of moderate complications following tongue base treatment, per treatment session, was 4.6 per cent. There were no major complications in our study population.

In this study, the incidence of complications of temperature-controlled radiofrequency treatment of the palate, uvula and tongue base was low. Temperature-controlled radiofrequency is a safe treatment modality for patients with sleep-disordered breathing and can be performed as a day case procedure. We recommend day admission for patients undergoing radiofrequency of the tongue base, in view of the potential for severe complications and airway compromise.

To investigate methods of treating diffuse osteoradionecrosis of the temporal bone in cases of nasopharyngeal carcinoma, following radiotherapy.

Retrospective.

Fourteen post-irradiation nasopharyngeal carcinoma patients (n = 14 ears) with diffuse osteoradionecrosis received surgical treatment from March 1994 to May 2005. The patients underwent radical mastoidectomy (five ears), extensive radical mastoidectomy (one ear), or radical mastoidectomy and obliteration with local vascularised fascia flaps (eight ears).

Six ears fully recovered; two ears were still infectious but sequestrum had not re-formed; five ears (50 per cent) still had repeated suppuration and did not epithelialise; and one ear had local re-formation of sequestrum requiring periodic dressing changes.

Diffuse osteoradionecrosis of the temporal bone following radiotherapy for nasopharyngeal carcinoma is difficult to treat surgically. The main objective of surgery is to facilitate drainage and to prevent complications. Radical mastoidectomy and obliteration with local vascularised flaps is an effective method.

Due to problems with long waiting times for assessment of vertiginous patients (more than 24 weeks), we changed practice and instituted a pre-ENT balance clinic assessment; we then audited the results. In particular, we looked at the subgroup with benign positional paroxysmal vertigo.

One hundred and fifteen patients were seen at the pre-ENT balance clinic from October 2003 to September 2004. Those diagnosed with benign positional paroxysmal vertigo received particle repositioning therapy at the same clinic and did not subsequently need ENT assessment.

By the end of the audit period, waiting times were reduced to three weeks, and more than one-quarter of vertiginous patients (i.e. those diagnosed with benign positional paroxysmal vertigo) did not need to be reviewed at an ENT clinic.

We believe this to be the first study to present prospective data showing that patients with benign positional paroxysmal vertigo may be safely diagnosed and effectively managed at a pre-ENT balance clinic.

To identify the nature of Woodruff's plexus, which has been frequently mentioned in the rhinological literature but has never been properly characterised.

A study using 21 cadaveric specimens, combining microdissection of the mucosa of the posterior part of the inferior meatus, Spalteholz ‘clearing’ of specimens injected with latex ink, and histological analysis of sections of the inferior meatal mucosa.

Microdissection revealed a superficial plexus of thin walled vessels in the inferior meatus, which were also seen in cleared, injected specimens. Histological sections showed these vessels to be large, thin walled veins with very little muscle or fibrous tissue, within a thin mucosa relatively devoid of other structures.

Woodruff's plexus is a venous plexus in the posterior part of the inferior meatus.

This is the first time Woodruff's plexus has been properly characterised. Whilst the significance of the plexus itself is uncertain, its long overdue identification as a venous plexus provides a platform for further study and discussion.

There is growing interest in the presence of Helicobacter pylori in the upper aerodigestive tract, and in the middle ear in patients with otitis media with effusion. Some studies have reported detecting H pylori in the middle ear, although reports to the contrary exist. In this study, we critically evaluate the evidence for the theory that H pylori in the middle ear plays a role in otitis media with effusion.

We undertook a systematic review of all available studies investigating the presence of H pylori in the middle ear of patients with otitis media with effusion. The current literature was critically analysed using the key words and phrases ‘Helicobacter pylori’ ‘otitis media with effusion’, ‘serous otitis media’, ‘glue ear’ and ‘middle ear’. Six original research papers were identified, studying a total of 203 patients and 27 controls; two of these papers were randomised, controlled studies and four were prospective, cohort studies.

At present, there is poor evidence for the existence of H pylori-associated otitis media with effusion.

Further research in the field is needed in order to delineate the presence of H pylori and its role in the pathogenesis of otitis media with effusion.

To evaluate the relationship between the incidence of primary post-tonsillectomy haemorrhage and the daily weather condition, over a five-year period.

This was a retrospective study carried out in the ENT department of the Split University Hospital between January 2000 and December 2004.

Out of 3377 patients undergoing tonsillectomy, primary post-operative haemorrhage occurred in 83 (2.5 per cent). The season, daily atmospheric pressure and daily change in atmospheric pressure did not have any significant influence on post-tonsillectomy haemorrhage incidence. However, there was a statistically significant increase in the incidence of primary post-operative haemorrhage when cyclonic conditions prevailed (p = 0.035).

The incidence of primary post-tonsillectomy haemorrhage in our study population was 2.5 per cent. Avoiding tonsillectomy during cyclonic weather conditions may reduce the incidence of primary post-tonsillectomy haemorrhage.

To determine the impact of a patient's gender on the clinical presentation of chronic rhinosinusitis with and without nasal polyposis.

Prospective study of 514 adult patients who presented with chronic rhinosinusitis with and without nasal polyposis. The patients were divided into two groups based on gender: female (n = 273) and male (n = 241). The following data were collected: presenting symptoms, co-morbidities, nasal endoscopy and sinus computed tomography findings, diagnosis, and outcome of surgery. Statistical analysis was performed using the chi-square test, with statistical significance set at p < 0.05.

Facial pain and headache were more prevalent among women, while nasal obstruction was more prevalent among men (p < 0.05). There was no statistically significant difference in the prevalence of environmental allergy, asthma, psychiatric illness or anatomical variants obstructing the osteomeatal unit, comparing the genders. Chronic rhinosinusitis without polyposis was the more common diagnosis among women, while chronic rhinosinusitis with polyposis was the more common diagnosis among men (p < 0.05). Following surgery, a higher percentage of male patients reported improvement in nasal obstruction (p < 0.05), but there was no statistically significant difference in the improvement of the other presenting symptoms, comparing the genders.

Women who suffer from chronic rhinosinusitis are more likely to complain of facial pain or headache on presentation and to be diagnosed with chronic rhinosinusitis without polyposis. On the other hand, men are more likely to complain of nasal obstruction, to be diagnosed with chronic rhinosinusitis with polyposis, and to report improvement in nasal obstruction following surgery.

To report a rare genus of a fungal family commonly affecting the sinonasal region, which presented as a fungal granuloma of the inferior turbinate in an immunocompetent host. Such a case has not previously been reported.

A 49-year-old man presented with nasal conidiobolus limited to the left inferior turbinate, despite pre-operative fungal culture and tissue biopsy being negative for any fungal growth. On computed tomography scanning of the paranasal sinuses, and peri-operatively, the left inferior turbinate was seen to be enlarged and a bony, cartilaginous spur was found to impinge deep into the inferior turbinate. The spur may have caused microtrauma suitable for spore implantation, leading to fungal granuloma development. This unusual presentation highlights the fact that excision biopsy is diagnostic and therapeutic in such cases.

Conidiobolus coronata of the inferior turbinate is rare. Such a fungal granuloma may be large enough to be confused with a benign or malignant lesion of the nasal cavity.

Laryngopharyngeal reflux is increasingly being implicated in several otolaryngological disorders.

To study a potential correlation between pre-operative laryngopharyngeal reflux and wound healing and recovery after tonsillectomy, based on subjective and objective findings.

A prospective, blinded study was undertaken, including 60 patients scheduled for tonsillectomy, divided into two equal groups: a study group (group A) with pre-operative laryngopharyngeal reflux documented using ambulatory 24-hour pH monitoring; and a control group (group B) without laryngopharyngeal reflux.

Group A had significantly higher pain scores on the seventh and 14th post-operative days (p = 0.022 and p = 0.000, respectively) and took a significantly longer time to return to normal eating (p = 0.013), compared with group B. Group A also showed significantly slower healing on the seventh and 14th post-operative days, as estimated by assessing the grade of post-operative slough formation (p = 0.016 and p = 0.029, respectively). A significant correlation between the number of pharyngeal reflux episodes and the degree of post-operative slough was also found.

Laryngopharyngeal reflux can significantly decrease wound healing following tonsillectomy. Therefore, pre-operative recognition and management of this condition is desirable in order to eliminate its negative post-operative effect.

A clear and detailed clinical history is essential in the assessment of patients with balance symptoms. The aim of this study was to assess the usefulness of open-ended questionnaires in the specialist balance clinic.

Fifty-four consecutive new patients completed an open-ended questionnaire, prior to a consultation in which the clinical history was taken using a standardised proforma. The results of the two were compared.

The open-ended questionnaires provided patient-centred data, and did not provide clinicians with sufficient data for diagnosis. Patients were more likely to respond in the affirmative when asked about symptoms directly, than to report the same symptoms spontaneously on an open-ended questionnaire. When questions had a number of possible answers, patients were more likely to report them in full in an open-ended questionnaire than to provide a response during direct questioning.

To review the presentation, risk factors and management of paroxysmal laryngospasm.

Retrospective review of cases.

A teaching hospital otolaryngology department with a subspecialty interest in airway disorders.

All patients diagnosed with laryngospasm over a two-year period were reviewed. Information was obtained about disease presentation, risk factors, management and symptom resolution.

Laryngospasm was diagnosed in nine women and six men. The average age at presentation was 56±6.5 years, and there was an 80 per cent association with gastroesophageal reflux disease. Proton pump inhibitors led to complete symptom resolution in six patients and to partial symptomatic relief, requiring no further treatment, in a further four patients. Of the remaining five patients unresponsive to proton pump inhibitor therapy, two continued to experience syncopal episodes due to laryngospasm. Both these patients achieved complete remission after laryngeal botulinum toxin injection. Symptoms recurred after three to four months and were successfully treated with a repeat injection.

The primary risk factor for spontaneous laryngospasm is laryngopharyngeal reflux. Symptoms are distressing and may be relieved in most cases by treatment aimed at suppressing gastric acid secretion. Laryngeal botulinum toxin injection appears to be a viable treatment modality in selected patients with refractory symptoms.