With easier access to more sophisticated imaging techniques, the investigation of vocal fold palsy is reassessed. A questionnaire was sent to all ENT surgeons in the UK to establish which imaging techniques are available to ENT departments and which tests are currently requested during the investigation of vocal fold palsy.

An extensive literature review established the aetiology of vocal fold palsy and the sensitivity and specificity of radiological investigations.

A simple protocol is proposed which would be suitable to implement in the majority of ENT departments in the UK.

Subtotal petrosectomy with external canal overclosure has been used in the management of 10 patients with chronic suppurative otitis media in the past four years. These patients fall into two categories. One group consisted of patients with end-stage chronically discharging mastoid cavities, despite aggressive medical therapy. The other group comprised patients who had developed disabling peripheral vestibular symptoms and had a mastoid cavity from past surgery for chronic otitis media. In both groups the affected ear had absent or poor auditory function. In the second group, a translabyrinthine section of the vestibular and/or cochlear nerves was performed in conjunction with subtotal petrosectomy

The procedure has been very successful in relieving the persistent otorrhoea, giving the patient an ear without a cavity that would need regular care. No restriction on swimming and participation in other water sports is an additional advantage.

Illustrative cases are used to discuss the technique and indications.

When performing translabyrinthine surgery for acoustic neuroma, the surgeon opens the cerebrospinal fluid space. To prevent the development of post-operative meningitis, the surgical defect should be closed reliably in a watertight fashion. To date, this has been done with success in 12 patients altogether using a self-curing bone cement (ionomeric cement). During follow-up for a maximum of three years there has been no evidence of cerebrospinal fluid leaks.

Long-term results of allograft ossiculoplasty with erosion of the long process of the incus in 44 patients are described. The pyramidal-shaped allograft leans on the stapes, the remaining part of the incus and the side of the malleus - forming a ‘tripod’ shape or construction.

The study includes two groups of patients: group A (34 patients) in whom the pre-operative three-frequency average air-bone gap was 20 dB or more and group B (10 patients), in whom the pre-operative air-bone gap was less than 20 dB. In the latter group the indication for surgery was not their hearing loss, but a different pathological condition (infected retraction pocket, a cholesteatoma, etc.) which necessitated surgical disconnection of the chain during the operation.

The average period of follow-up 46 months for group A and 24.9 months for group B. In group A, the preoperative average air-bone gap was 33 dB. Following surgery, the air-bone gap was 20 dB or less in 27 ears (79 per cent), and 10 dB or less in 18 of them (53 per cent). In group B, pre-operatively, the average air-bone gap was 11 dB. Following surgery, the air-bone gap was either better than before the operation or did not increase by more than 5 dB in eight patients (80 per cent).

Comparison of the audiometric results of 20 patients after mean follow-up times of 23.8 months and 64.9 months shows that no deterioration of hearing occurred in the intervening period. Graft extrusion was not observed in any of the operated ears.

Based on this review of 1192 intranasal sinus procedures under endoscopic control with video assistance, the risk of major complications was estimated to be about 1.3 per cent. Ethmoidectomy was the most hazardous procedure. Operation by a right-handed surgeon standing on the right side of the patient was an added risk factor. We stress ways of achieving prevention, peroperative recognition of cerebrospinal fluid leaks and proper management of complications.

Thecase records and histology of 34 patients with vocal process granulomata were reviewed. The five patients presenting most recently with idiopathic vocal process granulomata were investigated by axial computerized tomography (CT). Increased density of the arytenoid cartilage on the side of the lesion was found in all five cases. It is suggested that this indicates cartilage ossification, secondary to periochondritis. This perichondritis, playing either a primary or a secondary role in granuloma development, may explain the annoying tendency of vocal fold granulomata to recur after excision.

Thirty patients with external laryngeal trauma were analysed retrospectively. Injuries were mostly caused by motor vehicle accidents (car = 36.7 percent; motorcycle = 23.3 per cent). The main presenting symptoms and signs were hoarseness, neck tenderness, dysphagia, and neck emphysema. Sites of laryngeal injury included arytenoid swelling, vocal fold injury, soft tissue contusion or superficial mucosal laceration, cricoarytenoid dislocation, thyroid fracture, epiglottic fracture and mixed injuries. Treatment was varied depending on the severity of the injuries. Sixteen cases were managed conservatively by medical treatment; two cases received intubation; four cases were treated initially by tracheostomy; eight cases received surgical repair and/or reconstruction; 11 cases made a full recovery of the voice and 18 cases fair voice recovery due to either sustained vocal fold swelling or limitation of vocal fold movement. One case was graded as poor. Twenty-eight cases had good airway patency and two cases fair airway patency. A delay in the early detection of laryngeal trauma may precipitate into life-threatening airway problems, therefore prompt and accurate diagnosis should be followed immediately by skilful airway management.

A series of 59 patients of all ages with recurrent respiratory papillomatosis (RRP) treated over an 18-year period is presented. A number of these patients were initially diagnosed in childhood but required treatment throughout adult life. The frequency of laser treatment was not related to either disease duration or age at onset. In 28 patients, the HPV type was identified, showing that HPV type 11 was more common in children and ran a more protracted clinical course. The requirement for tracheostomy in this series was small, whereas the incidence of malignant change in adult patients was significant

Primary tracheal tumours are extremely rare and present with widely variant clinical and histological features. Treatment methods vary considerably, and few studies have sought to provide adequate guidelines. A retrospective analysis was carried out of all patients treated in our unit between 1965 and 1990. Our experience deals almost exclusively with high tracheal tumours involving the adjacent subglottic region. Squamous carcinoma (SCC) and adenoid cystic carcinoma (ACC) were the commonest subtypes, and presented with dyspnoea and hoarseness as the most frequent symptoms. ACCs occurred commonly in young individuals, presented insidiously, and ran a long, and often, unpredictable course. Endoscopic evaluation revealed the majority of the lesions to be bulky and obstructive in nature. Primary surgery with adjuvant radical radiotherapy, when indicated, appeared to provide optimal results. Debulking surgery followed by radiotherapy provided effective and lasting control in two cases of ACC. Other malignant subtypes behaved aggressively and progressed uncontrolled.

A modification of the CO2 laser hand-piece is presented which utilizes a simple finger controlled mechanical shutter. This instrument safeguards against accidental direction of the laser beam.

A burning sensation in the throat is often complained of by patients, but this symptom has been neglected in the literature. To emphasize its importance, should we give the name ‘caloripharyngeus’ to the symptom of burning in the throat? A preliminary study of 30 patients with the sensation of burning in the throat is presented in this study. Of the patients studied 73.33 per cent had hyperacidity detected for the first time. Reflux was presented in only one patient; four patients showed oesophagitis in the lower one-third of the oeosphagus; 90 per cent of the patients responded to antacids. We suggest that one of the causes of burning in the throat is a referred sensation due to hyperacidity.

An aberrant internal carotid artery in a young woman complaining of pulsatile tinnitus and conductive hearing loss was diagnosed pre-operatively by CT scan and angiographic findings. An exploratory tympanotomy was performed in order to evaluate the cause of the severe conductive hearing loss. It was possible to detect a large persistent stapedial artery associated with a stapedial fixation of unknown cause. Despite these vascular anomalies a stapedotomy was performed successfully.

Four cases of first branchial arch defects are presented. The literature relating to such defects is reviewed and a possible embyrogenic mechanism is proposed with particular reference to the disposition of the facial nerve. The classification of these defects into Types I and II by Work (1972) is supported

Angioleiomyoma of the nasal cavity is an extremely rare tumour (Sawada, 1990). We present an unusual case of angioleiomyoma arising from the lateral wall of the nasal cavity without any symptoms of pain or epistaxis. Another unusual feature was that the tumour clinically resembled an inverted papilloma.

Uncontrolled epistaxis may require a long hospital stay, multiple blood transfusions and multiple arterial ligations. Thiscase report highlights vertebro-carotid anastomosis as a rare cause of uncontrolled epistaxis. The importance ofangiography in the identification of rare arterial anastomoses is stressed.

The localization of Leishmania spp. in the larynx is rare but it has recently been described in patients infected by humanimmunodeficiency virus (HIV). The normal treatment given is antimonials. We describe a case of isolated leishmaniasis inthe larynx which was cured by surgery. Our patient was a 47-year-old man who had suffered visceral leishmaniasis in hischildhood with no immunosuppression.

The clinical presentation and management of a case of self-inflicted laryngopharyngectomy in a 48-year-old male psychiatric patient with a paranoid disorder is described

Inhalation of a foreign body is a serious event. The number of foreign bodies that become impacted in the larynx is small and requires urgent recognition. We describe the case of a six-month-old baby with an impacted open safety pin in the larynx. The sharp end of the safety pin was upwards and had penetrated the anterior end of the left vocal fold. We discuss the management and describe our method of removal of the foreign body. Tracheostomy was not required in this case and the child had an uneventful recovery

A brief review of the literature is included

Internal jugular vein ectasia is a venous anomaly commonly presenting as a unilateral neck swelling in children and adults. Literature reports of bilateral presentation are rare. Bilateral Doppler ultrasonography is the diagnostic investigation of choice. The possible pathology, aetiology and management are discussed. Conservative management of bilateral cases is recommended in uncomplicated cases