Posterior fossa vistibular neurectomy has become one of the most effective surgincal procedures for control of vertigo symptoms in Menière's disease. A small group patients continue to have vertigo and demonstratablke vestibular function by electronystagmography (ENG) post-operatively. Another group of patients may have also. In an effort to correlate hitological findings with clinical outcome, nerve biopsies were comapared with clinical, audiometric and ENG results. Results of this study demonstratge that complete reduction of vestibylar response (on calorica testing) and clinical cure of vertigo can be obtained despite a variable number of nerve fibres at vestibular neurectomy.

A labyrinthectomy is known to relieve vertigo successfully in the majority of patients who suffer from Menière's disease and have non-serviceable hearing in the affected ear. It is assumed that the procedure reduces disability, helps the patient to return to work and improves the quality of life. Eighteen patients who underwent a transmastoid drill-out labyrinthectomy between 1980 and 1990 were interviewed and an attempt was made to evaluate the success of the operation in accordance with the guidelines set out by the AAO-HNS 1985. In the present series it was noted that although vertigo was relieved in 89 per cent of patients after labyrinthectomy, only 50 per cent of them returned to work. In this study, the age and occupation of the patient at the time of surgery and the relief of vertigo did not accurately predict whether or not a patient returned to work.

In this prospective study, the author studied four local ENT departments to discover how many temporal bones were being harvested. The results show that only eight per cent of routine post mortems have temporal bones removed.

Obstruction of the nasal valve is an important cause of chronic nasal obstruction in adults. In a series of 500 patients, obstruction at the level of the nasal valve was diagnosed in 65 of them (13 per cent). The obstruction was unilateral in 57 patients (88 per cent). Forty-seven patients (72 per cent) had history of previous nasal surgery of accidental trauma. Causes of obstruction of the nasal valve included high septal deviations, a weak or deformed upper lateral cartilage, adhesions, and alar collapse. All patients underwent corrective nasal surgery and the surgical procedures were tailored according to the existing pathology. Post-operatively, the mean nasal patency score increased from 2.9 to 8.6, the mean nasal airflow increased from 579.5 to 727 cm/sec (at 150 Pa), and the mean nasal resistance decreased from 0.31 to 0.23 Pa/cm3 sec-1.

Sixteen unselected patients with nasal polyps had the levels of substance P and IgE decapeptide measured by ELISA in the oedema fluids and their matched sera. All 16 samples had low levels of substance P in their sera and had high level of substance P in eight samples of nasal polyp oedema. There was a considerable variation in the values of IgE decapeptide found in the sera but 14 polyp oedema fluids had high levels of IgE decapeptide. This study supports the idea that there is a linkage between the cellular and neurovascular responses. High levels of IgE decapeptide suggest that mast cell reactions occur in the majority of cases and that IgE may be implicated in the process of mast cell degranulation.

The effectiveness of some modifications of the Caldwell-Luc standard procedure in the prevention of postoperative mid-facial sensitivity disorders was investigated in a prospective comparative study at the ENT Department, Faculty of Medicine, University of Athens, Greece, from 1986–1992. Sixty-nine maxillary sinuses were operated on in 61 patients suffering from benign pathological conditions. The modifications concerned the type of mucoperiosteal incision and the site and size of the created anterior antrostomy. Only 8.7 per cent of the sinuses operated on by the modified technique presented with post-operative disorders whereas among those operated on by the classical technique, the ratio climbed to 33 per cent. In view of the findings of this study, the modifications applied can be valuable in treating non-extensive maxillary sinus disease with minimal post-operative sensitivity disorders.

The Kamami technique of laser-assisted uvulopalatoplasty has recently been introduced into British practice as an office-based multistage procedure for the treatment of snoring and, in certain cases, for obstructive sleep apnoea. We have treated 50 patients with simple snoring, with a minimum follow-up of six months. Six-month telephone interview follow-up has assessed partner and patient satisfaction, as well as willingness to undergo the procedure again. We have found the procedure easy to perform with no serious intra-operative complications. Thirty-four (68 per cent) of patients' partners have been definitely satisfied with the results of treatment, with 11 (22 per cent) definitely unsatisfied. However, only 25 of these 34 satisfied patients (76 per cent) would be prepared to undergo the treatment again with postoperative pain and discomfort cited as the reason in those who would not. The failure rate doubled between one and six months post-operatively. There have been no serious complications but a 40 per cent minor side-effect rate is noted. These results are discussed in the context of previously reported results, with consideration of future strategies to improve outcome.

Ploidy status of squamous cell carcinomas of the head and neck (SCCHN) from primary and recurrent tonsillar and tongue lesions has not been compared using image cytometry. We have measured and compared the DNA indices in 41 cases. There were 29 tongue SCCHN, 20/29 were primary and 9/29 were recurrent. Mean DNA index (DI) was 1.19 (range 0.70–1.81) and 1.28 (range 0.79–1.94) respectively. There were 12 tonsillar cases, 10/12 primary and two out of 12 recurrent. Mean DI was 0.84 (range 0.57–1.09) and 1.00 (range 0.98–1.02) respectively. Mean DNA indices of both primary carcinomas were lower than the mean DNA indices of the recurrent carcinomas. This difference between the two groups may be a reflection of their tumour biology. However, since our study is small no definite conclusions can be made at this stage. We aim in the future to evaluate the prognostic role of DNA indices of patients with paired primary and recurrent SCCHN. This may be of clinical value and improve the treatment modalities available to this group.

Candida species have the propensity to colonize and erode into the surface of silastic causing a loss of function. Colonization of silastic tracheo-oesophageal speaking-valves is an important cause of valve failure post-laryngectomy: the exact nature of the colonization is unknown and light microscopic studies have not been reported previously.

Microbiological examination of scrapings taken from the colonized oesophageal surface of failed speaking valves was arranged before sectioning for light microscopy. Conventional ultrathin sectioning of silastic was difficult, therefore 15 micrometre sections were cut after cooling the material to −30°C. These sections were then stained with toluidine blue; Candida species taking up the stain.

Microbiological examination of the colonies confirmed the predominance of Candida species in the biofilm. Light microscopy of the 15 micrometer sections revealed that the Candida colonies had invaded the silastic.

This work demonstrates that the colonization of the silastic valve prosthesis in the oesophageal area is due predominantly to Candida species which actively invade the structure of the silastic. This is an important cause of speaking-valve failure post-laryngectomy.

A restrospective study was performed on 61 eligible patients with stage III and IV (AJC/UICC Staging System) squamous carcinomas of the head and neck region who were treated with definitive radiotherapy with, or without, surgery. DNA contents were measured by flow cytometric analysis of archival paraffin blocks and were correlated with clinicopathological findings, tumour response and patient survival. Comparison of variables including treatment modality was performed for identification of significant prognostic factors. There were 28 diploid, 27 aneuploid tumours and the remaining six were questionable. All patients were followed-up for at least two years or until death.

Aneuploid tumours had a significantly higher S-phase fraction (percentage S-phase) (p<0.001). Neither ploidy nor percentage S-phase were found to have predictive value in tumour response or patient survival within the power of a sample size of 61. Twenty of the 27 (74 per cent) aneuploid tumours had a complete response (CR) whereas 19 out of 28 (68 per cent) diploid tumours achieved CR. Five-year survival by the Kaplan-Meier method was 33 per cent for both aneuploid and diploid tumours. However, nodal stage (N stage) was found to have significant predictive value in both tumour response and patient survival. The complete response for stage N0 patients was 96 per cent, N1 patients 61 per cent, N2 patients 60 per cent and 43 per cent for N3 patients (p<0.002). Similarly, the five year survival for the N0 and N3 groups of patients was 53 per cent and 29 per cent respectively (p<0.05).

We report a case of mucoepidermoid carcinoma of the middle ear, a site which does not appear to have been previously described. A discussion of four possible theories of pathogenesis are presented.

Multiple sclerosis is known to affect the myelin of the auditory pathway resulting in acute hearing loss. Two cases of sudden deafness due to multiple sclerosis have been evaluated by conventional audiometry, brainstem auditory evoked response audiometry and transtympanic electrocochleography. The abnormalities of the compound action potential in both patients (enhanced latency, abnormal adaptation using fast stimulus rate) and the normal receptor potentials (cochlear microphonic, summating potential), as well as the absence of brainstem responses suggest a disturbance of synchronization at the level of the first auditory neurone. The electrocochleography provides valuable information for the topodiagnosis of this and other neural hearing losses, especially in the absence of reliable brainstem responses.

Two cases are presented in which patients flying home shortly after translabyrinthine removal of a vestibular schwannoma (acoustic neuroma) developed acute bacterial meningitis on landing. This complication has not been described before. The incidence and management of CSF leaks after vestibular schwannoma surgery is also discussed.

A case is presented with irreversible blindness in one eye and restriction of the infratemporal visual field in the other eye, due to electrocoagulation performed for delayed bleeding after functional endoscopic sinus surgery (FESS). Although blindness due to rhinosurgery is a well-known, but rare complication, a review of the recent literature did not reveal a similar incident. The use of electrocoagulation especially under conditions of poor visualization, that may be the case in post-operative bleeding following (endoscopic) sinus surgery, is strongly discouraged.

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.

A case of recurrent epistaxis caused by bone wax in the nasal cavity is reported. This is the first reported case of a nasal complication due to surgical bone wax.

An important part of the initial assessment of children presenting with congenital nasal masses is to exclude an intracranial extension using either magnetic resonance imaging (MRI) or computed tomography (CT) imaging.

We present three patients with such lesions in which unusual radiological findings were noted as part of the investigations.

In this paper we present the first ever reported case of simultaneously occurring bilateral antrochoanal polyps in a fit 12-year-old child. The antrochoanal polyps (ACP) were removed using functional endoscopic sinus surgery (FESS) which achieved complete cure. Histological analysis of the polyps showed them to be of benign inflammatory origin.

A lipoma situated within the posterior wall of the nasopharynx is reported. Only three lipomas of the nasopharynx in adults have previously been reported. The value of CT scan and cytology in making the preoperative diagnosis of a lipoma at this location is discussed.

A case is presented of a rare intraductal papilloma being found simultaneously with a parotid duct cyst, which is a relatively common parotid disorder. The papilloma most probably played a significant role in the obstruction of the duct and thus caused the ductal cyst. Intraductal papillomas have been mostly described in minor salivary glands, but are rare in the parotid gland.