The treatment of chronic maxillary sinusitis aims at the re-establishment of proper aeration and drainage of the antrum. Middle meatal antrostomy offers ventilation and clearance of the antrum and has anatomical, physiological, physical and pathological basis.

This work included 66 cases of chronic maxillary sinusitis, for whom 94 operations of endoscopic middle meatal antrostomy were performed (38 unilateral and 28 bilateral procedures). Any associated anatomical variations and/or pathological abnormalities at the ostiomeatal area were dealt with. Follow-up of these cases for periods ranging from four to 12 months showed that 95.5 per cent of the cases experienced subjective improvement. Endoscopically 96.8 per cent of the antrostomies were patent and 94.7 per cent of the maxillary sinuses were clear and regained healthy mucosa. The author concluded that middle meatal antrostomy, when done endoscopically, is a safe procedure with good results

Over a 40 month period, 219 patients with AIDS were seen at St. Mary's Hospital, London. Kaposi's sarcoma, one of the criteria for diagnosing the syndrome, was the presenting feature in 62 patients. Eighty four patients developed Kaposi's sarcoma at some stage of their disease and the head and neck region was involved in 56 of them.

Although Kaposi's sarcoma is rarely life threatening in AIDS, potential airway obstruction, pain or cosmetic disfigurement may justify treating the lesion. Whilst cutaneous tumours may be managed by using radiotherapy (16 Gray in four fractions over four days), this treatment produces a sever mucositis when used to treat mucosal disease; we, therefore use a combination of vincristine and bleomycin for this.

The authors report on a series of 25 patients who, in the process of undergoing tympanoplasty, were noted to have erosion of the long process of the incus. This was rapaired with bone pâté in an attempt to restore ossicular continuity. The methods and results are presented and the prospects for the future are discussed.

The House and Brackmann grading system has been recommended as a universal standard for assessing the degree of facial palsy. This study examined the inter-observer reliability of this system. Three observers assigned a grade to each patient, examined independently, on the same day. Forty patients with a unilateral facial palsy of varying aetiology and severity were assessed. Of the 120 judgements, eight were in dispute, by a maximum of one grade, giving an inter-observer reliability of 93 per cent.

We conclude that the House and Brackmann grading system is a simple and robust method of assessing facial function.

A clinicopathological study of 51 cases of adenoid cystic carcinoma in the head and neck region seen over a period of 20 years is presented. The correlation between various histological features and their impact on the results is attempted. Longterm results with respect to loco-regional recurrences, distant metastases and survival with various modalities of therapy are presented. Although this is a small series, radical surgery in keeping with the aim of avoiding undue mutilation, thus preserving the quality of life, followed by a full course of radiotherapy has been the mainstay of treatment and the results here presented justify this approach.

The rigid Hopkins endoscope has been applied to simplify the operation of dacryocystorhinostomy, preventing unnecessary trauma to the medial orbital tissues. The success of the surgical technique is absolutely dependent on a thorough knowledge of the relevant surgical anatomy.

In a series of 407 patients suffering from acute frontal sinusitis, 159 sinues of 134 patients were trephined. Initial radiography of the operated sinues pointed out a slight tendency to overdiagnosis; 19 (12 per cent) of the 157 sinuses with positive radiographic signs did not yield secretion. Radiography missed only two true cases of fluid retention. Accuracy of diagnosis by radiography was 87 per cent.

Initial ultrasonography gave a sign of retained secretion in 127 cases, of which 122 (96 per cent) were true positive However, 18(13 per cent) tracings of the 140 sinuses with secretion gave wrong negative findings. Accuracy of diagnosis by ultrasonography was 86 per cent. It seems evident, that ultasonography measures better retained secretion (excluding very small amounts) and radiography shows better mucosal swellings.

To determine whether translabyrinthine acoustic surgery may result in a drill-generated, bone-conducted sensorineural hearing impairment in the contralateral ear, the audiograms from 50 consecutive patients with acoustic neuromas undergoing the translabyrinthine approach were compared before and three months after surgery. No case of sensorineural hearing impairment could be demonstrated post-operatively.

Obstruction of the laryngeal airway is a life threatening problem due normally to obstructive pathology within the upper aero-digestive tract. We describe four cases of laryngeal stridor (two adults and two children) of psychogenic origin, one of which required a tracheostomy. The literature is reviewed and the subsequent pattern of this disease documented on the basis of 28 patients previously described.

Every year 400 to 450 cases of Rhinosporidium are reported from Trivandrum Medical College. Twenty five swabs were collected from patients suffering from Rhinosporidiosis and cultured in standard media. Positive results were obtained in 23 cases. The conidia produced from the colony were compared with the structures obtained from the patient material. Light microscopy using histopathological techniques were used. The consistant appearance of the organism in patient material, the repeatability of growth in subcultures and the negative growth in controls indicated that the organism grown in cultures is the causative agent of the disease. The effect of parameters like pH, temperatures, etc, were also studied.

Submucosal diathermy (SMD) of the inferior turbinates is widely used, although its effect histologically has not been well shown. We attempted to demonstrate the acute histological changes of SMD by performing it immediately prior to inferior turbinectomy. The results found help to explain the unpredictability of producing a clinical response.

In a continually renewing cell population, stem cells can be regarded as a reservoir of cells with a high capacity for self renewal that give rise to all differentiated progeny. They are the primary source for the generation and maintenance of cellular diversity and tissue homeostasis. In general, neoplasms manifest differentiation pathways similar to those found in the development and renewal of the normal tissues from which they arise. This feature serves as a basis for classification schemes of neoplasms and, as in the normal tissues, there is usually an inverse correlation between proliferative capacity and differentiation within the neoplasms. In our postulate of the histogenesis of salivary gland neoplasia, we evoke the stem cell model to account for the considerable phenotypic heterogeneity seen with these neoplasms. We further consider the neoplasms and, in particular, their myoepithelial constituencies to be manifestations of escape from normal regulatory mechanisms that determine differentiation pathways which a stem cell and its progeny can take. Clinical and basic scientific evidence are presented to support the postulate and also to point to the mitigating role that myoepithelial differentiation has in the biological course of salivary gland neoplasms.

The study was undertaken to define the characteristics of spontaneous eardrum perforation in acute otitis media. Eighty (29.5 per cent) out of 271 children with acute otitis media had eardrums which perforated. An increased incidence of perforation was associated with a previous history of otitis media.

All perforations were small and limited exclusively to the pars tensa. In 85 per cent of the patients, the perforation was located in the anterior-inferior quadrant. It had smooth margins enabling free drainage of pus and was associated with a favourable clinical course. In the remaining 15 per cent of the cases, the perforation was located in the posterior-superior quandrant. It had a nipple-like shape with a tiny opening that did not allow pus to drain sufficiently from the middle ear.

The perforation closed in 94 per cent of the patients within one month. The healing process was gradual and following perforation closure, there was evidence of middle ear effusion for some time before normal aeration was regained.

An analysis of a series of 100 patients aged 60 years or over, referred by their General Practitioner to the Department of Otolaryngology, Addenbrooke's Hospital, specifically for the provision of a hearing aid, is presented.

Forty-six per cent of patients failed to satisfy the criteria suggested by the Technicians, Therapists and Scientists in Audiology as a screening for treatable pathology.

This study has shown that the existing referral pattern of general practitioner to consultant otolaryngologist for the provision of a hearing aid reflects the highest quality of care for the patient.

Direct referral or open access of patients for hearing aid fitting may risk failure to diagnose early and treatable conditions.

One hundred children and twenty adults were randomly allocated to guillotine or dissection tonsillectomy operations. The study was prospective and double-blind. In the children, the guillotine technique had demonstrable advantages over the dissection technique in terms of duration of operation, blood loss and post-operative pain. There was no significant morbidity in either group. In the adults, the random allocation of patients into these groups was found to be technically unsatisfactory and this arm of the study was abandoned after twenty patients.

The technique of antroscopy affords an accurate assessment of chronic sinus disease. It was performed in twelve patients suffering from lepromatous leprosy in order to determine the type, nature and site of the lesion. Antral involvement with lepromatous leprosy may begin with a localized area of erythema progressing to granuloma formation or ulceration. The antero-inferior part of the antrum is the most commonly affected site.

A 69-year-old woman with severe rheumatoid arthritis presented with a history of chronic otitis and a facial nerve paralysis. She was found to have a rheumatoid nodule involving the mastoid and mesotympanum. This is believed to be the first reported case of a rheumatoid nodule involving the temporal bone.

The Rhinitis Clinic at the Royal National Throat Nose and Ear Hospital is a direct referral clinic dealing with approximately 300 new cases a year. Last year three cases of spontaneous CSF rhinorrhoea were liagnosed. In each case long term topical steriod sprays had been prescribed and the patients had been eferred for further management of their ‘rhinitis’. Spontaneous CSF rhinorrhoea is potentially life hreatening as failure to recognize the problem may lead to the development of meningitis and possibly death. The diagnosis is simple and is based on a good clinical history which may be confirmed by chemical pathology. Radiology is often non-contributory, the site of the leak may have to be identified at surgery. Morbidity and mortality are reduced if an extracranial, trans-nasal/external ethmoid route for repair of the istula is employed.

Three case reports are presented and the diagnosis and management of CSF rhinorrhoea is reviewed.

Abstract The authors report 18 patients who presented to the ENT department with isolated cough, which had begun one month to 14 years previously. As the ENT examination was negative, the patients were referred to the Department of General Medicine where a bronchial reactivity test with acetylcholine was found to be positive, leading to a diagnosis of airway hyperreactivity. The group was predominantly female (15/18) and atopy was rare; indeed, only one patient, who had a history of allergic rhinitis, was found to be atopic. Bronchodilators and inhaled steroids cured or helped the cough in 16/18 patients. When a patient presents with chronic cough without other respiratory symptoms it is important to consider a diagnosis of airway hyperreactivity and to confirm this with a challenge test of bronchoconstriction