We present two cases of suppurative sinusitis that presented to our casualty department over a one-week period. Both patients suffered complications of the disease secondary to extension of the inflammatory process beyond the bony confines of the sinus. Neither of the patients had a previous history of sinus disease. The first patient deteriorated suddenly 24 hours after admission. The initial computed tomography (CT) scan failed to demonstrate a developing subdural empyema. This complication was confirmed following repeat scanning 24 hours later and the patient required urgent neurosurgical intervention and drainage. The second patient presented with periorbital cellulitis secondary to sinusitis and suffered a grand mal seziure on admission. Once again initial CT scan changes were subtle and significant intracranial extension was not noted until the subsequent magnetic resonance imaging (MRI) scan was performed.

The purpose of this paper is to highlight the potential dangers over reliance on CT scanning in diagnosing early intracranial spread of sinus disease and we emphasise that the clinician must interpret any radiological investigations in light of the associated clinical findings.

The nasal and the paranasal sinuses are a rare site for solitary fibrous tumours. There have been no previously reported cases in the English literature, with eight cases in the world literature (Witkin and Rosai, 1991; Zuckerberg et al., 1991). We present a case of a solitary fibrous tumour arising in the nasal cavity and review the previous reports.

A fracture of the lamina papyracea as a result of nasal packing, though plausible is undocumented. A case is presented, with a cautionary note to avoid the use of excessive pressure in packs and balloons when attempting to control epistaxis in elderly patients.

The case histories are presented of three patients with circumferential subglottic stenoses who presented, over a six-month period, to a teaching hospital's Otolaryngology department. No recognisable cause for their subglottic stenoses was found. Traumatic, iatrogenic, infectious and specific inflammatory processes were excluded. The histopathological evidence suggested a chronic inflammatory process. All patients were treated by resecting the stenosis with a carbon dioxide laser. One patient required an emergency tracheostomy for airway obstruction. A review of the published literature on this rare condition is given.

Glomus jugulare tumours with metastases are rare as the diagnosis of metastases in this condition can be difficult.

In the past this diagnosis has been made on histology of the metastatic lesions which were identified on clinical grounds. This is one of the reasons why there have been only 20 reported cases in the literature up to 1990 (Johnstone et al., 1990). This case report examines the role of meta-iodobenzylguanidine (MIBG) scintigraphy in the diagnosis of metastases. MIBG scintigraphy is an injected radionucleotide isotope scanning technique which is cheap, non-invasive, sensitive as well as being a specific investigation for identifying sites of ectopic neuroendocrine tissue. It may also have a role in the treatment of these tumours.

Malignant otitis externa is a necrotising infection of the external ear canal which may spread to include the mastoid and petrous parts of the temporal bone, leading to skull base osteomyelitis. It is almost exclusively caused by infection with Pseudomonas aeruginosa, and usually occurs in elderly non-insulin-dependent diabetic patients. However isolated cases have been reported in a small number of non-diabetic patients, particularly in children who are immunocompromised due to malignancy, malnutrition and severe anaemia. In 1984 a case of malignant otitis externa was reported in a child with an acquired immunodeficiency syndrome (AIDS)-like illness, prior to identification of the human immunodeficiency virus (HIV). Since that time further sporadic cases of this invasive infection have been reported in HIV and AIDS. We present two further cases and also a review of the current literature.

Myofibromatosis is an uncommon, usually cutaneous, condition in which there is a benign proliferation of myofibroblasts. Solitary and multicentric nodular forms with, and without, visceral involvement have been described. Infantile and adult sub-types have been reported, each having distinct clinicopathological features. Presentation in the head and neck is common. It is frequently misdiagnosed because of its peculiar histological features. The first documented cases of infantile and adult myofibromatosis involving the nasal cavity are reported.

Plexiform neurofibroma of the larynx is a rare disease. Three cases in children with airway obstruction are presented. After tumour reduction via a lateral pharyngotomy their tracheostomies could be closed. The surgical treatment of plexiform neurofibroma of the superior laryngeal nerve is discussed and conservative, subtotal resection is recommended.

Osteosarcoma is the most common primary malignant tumour of bone and it usually metastasises to the lung. In the nasal cavity metastatic disease is extremely rare. We describe a case of osteosarcoma presenting with recurrent epistaxis, and proptosis due to secondaries in the nasal cavity. To our knowledge such a case has not been reported previously in the available English literature.

We present a unique case in which a multichannel cochlear implant device was explanted and the same device was re-implanted into the contralateral ear. A patient with bilateral total deafness secondary to head injury received an implant in his left ear but developed severe facial nerve stimulation. Because this stimulation could not be eliminated effectively with change of programming, it was decided to implant the contralateral ear. Since the device itself was functioning well, it was explanted from the left ear and re-implanted successfully into the right ear. Facial nerve stimulation was minimal in this ear and the patient demonstrated very good speech discrimination. To our knowledge, this is the first description of this strategy.

This paper reports an undiagnosed diabetic presenting to an otolaryngologist with sudden deafness of six days duration as the only symptom. Appropriate investigative and treatment measures resulted in recovery of hearing.

The authors report a clinical case of a primary malignant melanoma of the right palatine tonsil in a 75-year-old woman.

Neural-crest tumours, including neuroblastomas, express somatostatin receptors. This can be shown by radionuclide labelling of octreotide, a somatostatin analogue. Studies on imaging with this substance have dealt with childhood neuroblastomas. Olfactory neuroblastoma (aesthesioneuroblastoma) is a rare tumour in which somatostatin receptor content has not been analysed, nor have radionuclide methods for diagnostic purposes been described. We report a case of olfactory neuroblastoma, in which scanning with m In-labelled octreotide was performed. A strong uptake was seen at the base of the skull. This was confirmed as a recurrent tumour by magnetic resonance (MR) imaging. Uptake was also observed in the neck and chest, indicating extensive spread of the disease.

Somatostatin receptor expression has been shown to correlate with prognosis in childhood neuroblastoma. The accuracy of labelled octreotide in the diagnosis of olfactory neuroblastoma indicates that it might be useful in radionuclide therapy of patients with advanced disease, when no other treatment modalities are available.

Paranasal and rhinocerebral mucormycosis refers to uncommon opportunistic fungal infections, reported to occur especially in association with diabetic acidosis (the most common), immunosuppressive therapy, malignancy, or other chronic debilitating disorders. However, patients who have no underlying disease have occasionally been affected. According to the literature reviewed, only 13 well-documented cases without any predisposing factor have been previously reported. We describe a unique case of sphenoidal mucormycosis in an otherwise healthy individual, and the first patient to present with headache as the only symptom. We emphasize the importance of a high index of suspicion for early diagnosis and prompt management.

Malignancy is a major cause of vocal fold paralysis. Nevertheless, metastatic disease at the brainstem leading to high vagal paralysis is rarely encountered. We illustrate an unusual case of unilateral vocal fold paralysis caused by dural metastasis directly compressing on the nucleus ambiguus. The median position of the paralysed vocal fold is inconsistent with the Wagner and Grossman theory predicting the location of the lesion.

Unilateral secretory otitis media is a recognized presenting feature of nasopharyngeal neoplasia. In the two cases presented, biopsy from the nasopharynx revealed an unsuspected underlying adenocarcinoma. The need to biopsy the normal looking post-nasal space is highlighted.

Tuberculosis of the parotid gland is rare. It cannot be distinguished from a parotid tumour by clinical examination alone, so surgical exploration has usually been required for diagnosis. We present a case with the same diagnostic dilemma.

A post lingually deafened adult equilingual in Welsh and English, received rehabilitation in both languages following cochlear implantation.

Hearing acquisition was very similar in both languages, indicating that there is no need to vary the electrode coding strategy for different languages of Indo-European origin. The situation may be difficult for tonal languages such as Chinese.

Adenomatoid hyperplasia of palatal minor mucous glands is rare but significant because the clinical appearance mimics malignant disease. The typical history of a painless, indolent palatal swelling, together with the histological picture of benign glandular hyperplasia and hypertrophy, are illustrated in this report.

A rare case of an overlooked fractured metallic Fuller's tracheostomy tube in the posterior basal segment of the left lung is reported along with a review of the literature. Incidence, aetiology, delay in diagnosis, complications and management of overlooked foreign bodies are discussed. Various factors contributing to the fracture of tracheostomy tubes are reviewed.