External ear manifestations of sarcoidosis are rare. We review six cases in the literature and also report a case. The otolaryngologist plays an important role in making the diagnosis because of the ease of biopsy in all cases of sarcoidosis of the external ear.

A case of pneumosinus dilatans of the frontal sinus is presented. The findings on serial skull X-rays, performed on three occasions over a 10-year period, seem to support a developmental aetiology for this rare condition.

Rhinocerebral mucormycosis is a devastating, rapidly progressive and often fatal opportunistic fungal infection predominantly affecting individuals with underlying metabolic and/or immunological compromise. Intracranial extension of the disease has invariably been associated with mortality.

We present a review of optimum management of rhinocerebral mucormycosis and a case report of sinonasal mucormycosis with intracranial and orbital extension which was treated successfully with a combination of systemic liposomal amphotericin B therapy and wide surgical debridement.

Objectives: To describe the features of an oropharyngeal and hypopharyngeal myxoma.

Materials and methods: Case report of a 34-year-old patient operated upon for a dual-location tumour, and review of the literature.

Results: The myxoma is a rare tumour. Various head and neck locations have been described, but not (to our knowledge) a tumour in both the oropharynx and the hypopharynx. Multiple synchronous locations must be searched for, particularly regarding cardiac myxoma.

Conclusion: The myxoma is a rare, benign tumour, even rarer in the head and neck. Surgical treatment must be complete in order to avoid recurrences, and should be performed after assessment for cardiac involvement.

We describe a series of four patients who presented with ‘high globus pharyngeus’, who all had an abnormally curled epiglottis tip touching and indenting the tongue base. The actual incidence of ‘curling epiglottis’, as well as the potential impact of this variation in persistent globus symptoms, is not known. We therefore describe for the first time a series of patients with this anatomical variant of the epiglottis, each of whom experienced unresolved globus symptoms despite receiving intensive medical treatment. In the literature, the success rate for improvement in symptoms following medical treatment ranges from 68 to 80 per cent.

Following CO2 laser partial epiglottectomy, all four patients experienced complete relief of their symptoms.

We advocate consideration of this treatment for high globus pharyngeus that fails to respond to conservative treatment, in cases with proven curled epiglottis on endoscopic examination.

Traditionally, debulking of obstructing laryngeal tumours has been performed with cold steel instruments or CO2 lasers. With recent technological advances and increased availability of microdebriders, powered instrumentation for debulking laryngeal tumours has become a viable option. We describe the use of the Xomed laryngeal Tricut blade in re-establishing the airways in four patients with obstructing laryngeal tumours. In all cases a tracheostomy was avoided, thus allowing adequate time to stage each patient and tailor surgery to the individual.

Objectives: To report a rare presentation of dehiscent infraorbital canal associated with a maxillary antral cyst.

Case report: A 26-year-old woman presented with symptoms of right infraorbital nerve dysfunction experienced while travelling by aeroplane. She was subsequently diagnosed with dehiscent infraorbital canal and large maxillary antral cyst on computed tomography scanning. The cyst was removed by endoscopic sinus surgery, and the patient's symptoms resolved.

Discussion: The effects of barotrauma on the ears and paranasal sinuses are reviewed. This is the first report of infraorbital nerve dysfunction caused by altered atmospheric pressure in the presence of dehiscent infraorbital canal and maxillary antral cyst. Endoscopic sinus surgery was successful in relieving the symptoms in this case.

We report a rare case of primary B-cell lymphoma presenting as bilateral ear lobule swelling. A 56-year-old white man presented with a one-year history of painless swelling of both ear lobules. An excision biopsy confirmed B-cell lymphoma. Detailed systemic investigation confirmed the primary nature of the tumour. This tumour is rare in the ear lobule. A review of the English literature revealed no previously reported case of bilateral primary ear lobule involvement. Clinicians should be aware that this tumour can present as a primary in the ear lobules.

Arnold-Chiari malformations are a group of congenital hindbrain and spinal cord abnormalities characterized by herniation of the contents of the posterior cranial fossa caudally through the foramen magnum into the upper cervical spine. It is important to recognize Arnold-Chiari type I malformation in the differential diagnosis of adult vertigo cases. We present a 51-year-old patient with Arnold-Chiari type I malformation that was initially diagnosed as posterior semicircular canal benign paroxysmal positional vertigo.

Objectives: To assess the reduction of mucosal surface after total sphenoethmoidectomy.

Study design: Prospective study.

Methods: Twelve normal, consecutive computed tomography scans were used. Computed tomography measurements were made at two different levels: the cribriform plate, and the upper level of the maxillary antrum. The length of the lateral wall of the ethmoid sinus and the perimeter of each ethmoid cell were measured at each level and on each side. The whole perimeter of the ethmoid sinus was evaluated for each CT scan level. For each side and each level, the ratio between the ethmoid sinus perimeter and the lateral ethmoid wall length was calculated.

Results: The mean length of the lateral ethmoid sinus wall was 61.7±1.3 mm and 59.9±1.6 mm at the upper and lower parts of the ethmoid sinus, respectively. The mean ethmoid sinus perimeter was 263.2±11.5 mm and 250.4±11.1 mm at the upper and lower parts of the ethmoid sinus, respectively. No significant statistical difference was observed between measurements as a function of side (right or left) or level (upper or lower). The mean ratio between the ethmoid sinus perimeter and the lateral ethmoid wall length was 4.2.

Conclusion: After total sphenoethmoidectomy, the mucosal surface of the ethmoid sinuses is reduced by a factor of 4.2; about 76 per cent of the mucosa is removed during total sphenoethmoidectomy.

Polyarteritis nodosa is a systemic disease which affects the small to medium-sized muscular arteries. Sudden or progressive, bilateral hearing loss is a presenting otologic manifestation. To date, no case of cochlear implantation in patients with polyarteritis nodosa has been reported.

The authors present a case of polyarteritis nodosa (confirmed by biopsy) in a 71-year-old man with progressive, bilateral sensorineural hearing loss who underwent cochlear implantation. A successful full insertion of the Nucleus 3G electrode array was achieved without surgical or post-operative complications. The patient immediately showed a positive subjective response and, at three month post-operative evaluation, had gained useful open-set speech perception.

A review of five temporal bone cases with hearing loss and polyarteritis nodosa revealed the possibility of fibrosis and ossification in the basal turn of the cochlea, of which the surgeon should be aware prior to cochlear implantation.

Angiomyoma is an uncommon, benign, soft tissue tumour characterised by bundles of smooth muscle cells intermixed with numerous vascular channels, which usually develops in the lower extremities. Oral manifestations are quite rare. Most oral cases occur in the lips and tongue; angiomyoma affecting the buccal vestibule is very rare. A case of angiomyoma in the buccal vestibule with a normal karyotype is reported.

Salivary gland myoepitheliomas are rare tumours, accounting for less than 1 per cent of neoplasms of the salivary glands. Myoepithelioma of the palate is very rare, and only a few cases have been reported in the world literature. Histological and immunohistochemical analysis supports the myoepithelial origin of this tumour. Here, we report three cases of myoepithelioma of the palate in adult males and review previously reported cases.

Following surgery in the USA in 1992 to remove a large right cerebello-pontine angle tumour, a 39-year-old woman developed severe brainstem and cerebellar infarction. This left her with severe visual impairment and ataxia. She became able to communicate by means of an adapted finger-spelling alphabet. She had total hearing loss in the right ear and a mild to moderately severe sensorineural hearing loss in the left ear, and severe tinnitus heard throughout the head. Additionally, she experienced hypersensitivity to sound above normal conversational levels, which evoked a synaesthetic feeling of coldness across her upper torso. Previous linear analogue hearing aid fitting had not been beneficial for either hearing or tinnitus. Careful fitting of a digital hearing aid, together with tinnitus counselling, inhibited the patient's tinnitus to 25 per cent of its former intensity after a six month acclimatisation period, and improved communication.