Barotitis is an acute or chronic inflammation caused by environmental pressure changes. The most common cause is the pressure change during descent in civil aviation. To prevent barotitis the middle ear pressure has to be equalised several times during descent. This can be achieved by performing the Valsalva manoeuvre, but for children, many of whom have a dysfunction of the Eustachian tube, this is difficult to perform and they are therefore at high risk of developing barotitis during flight. The traditional treatment modalities of barotitis are inflation by a Politzer balloon, myringotomy or prophylactic grommet insertion. An alternative treatment or prophylactic measure is autoinflation using the Otovent® treatment set. This prophylaxis/treatment can be performed by the child with assistance from its parents as soon as possible or rather before the descent has started. The prevalence of barotitis amongst transit passengers was found to be highest in young children, 25 per cent, compared with adults, five per cent. Only 21 percent of the youngest children with negative middle ear pressure after flight managed a successful Valsalva's manoeuvre, whereas 82 per cent could increase the middle ear pressure inflating the Otovent® set. In conclusion we recommend autoinflation using the Otovent® set by children and adults with problems clearing the ears during flight.

Residual cholesteatoma was experimentally produced in guinea pigs by transplanting a free skin graft into the middle ear bulla. In group A, the graft was placed on the mucosa after scratching the surface with a pick, while in group B, it was placed on the bone surface following removal of the mucosa and drilling with a diamond burr. The group A procedure was conducted on the left ear and the group B procedure on the right ear in 12 guinea pigs. The animals were sacrificed at two, four and eight weeks after transplantation. In all 12 ears of group A, the graft kept its original flat shape, resembling an open type residue. In eight of 12 ears of group B, the graft grew forming a squamous pearl, while in the remaining four ears it retained a flat shape. The difference in configuration is thought to be due to the amount of granulation around the graft.

Biopsy of a middle ear mass can lead to facial paralysis when the mass is a facial nerve schwannoma. Immunostaining techniques were used to determine if nerve fibres might be present within the tumour mass. Nerve fibres were found to be widely disseminated throughout the tumour in eight of 23 facial nerve schwannomas. Antibodies to neurofilaments demonstrated single fibres, or small groups of fibres, that are very difficult to see with routine haematoxylin and eosin stains. The presence of fibres throughout some tumours makes biopsy of them likely to result in facial dysfunction.

Ninety-three patients with unilateral vestibular schwannomas were examined in a clinical, genetic and audiological study, to determine whether they had features associated with neurofibromatosis Type 1 or neurofibromatosis Type 2. In 91 families, one patient only was found to be affected with a unilateral vestibular schwannoma. Patients did have a few café-au-lait macules, but fewer than six in number. None of the patients satisfied the cutaneous diagnostic criteria for neurofibromatosis Type 1. Neither Lisch nodules nor presenile posterior subcapsular lenticular opacities or cortical opacities were a feature. Five patients with unilateral vestibular schwannomas are described where the clinical findings raised the possibility of neurofibromatosis Type 2. It is suggested that certain individuals with unilateral vestibular schwannomas are at risk of developing neurofibromatosis Type 2. Furthermore, the possibility of neurofibromatosis Type 2 should be considered if more than one individual in a family is found to be affected with a unilateral vestibular schwannoma.

Thirty New Zealand White rabbits underwent unilateral partial or complete removal of maxillary sinus mucosa in order to evaluate submucosal maxillary sinus glands. After three months, specimens were taken for examination from all operated on and control sinuses. Bacteriological cultures, light and electron microscopy were performed. Histopathological findings showed a decrease in the number of serous glands and significant inflammation was present in the sinus in which there was complete surgical removal. Electron microscopy revealed changes in the secretory cells of the serous glands in the regenerated postsurgical mucosa.

A retrospective study was carried out to determine the prevalence of abnormality in the paranasal sinuses in a British population having magnetic resonance imaging (MRI) scans for neurological signs and symptoms. The T2-weighted scans of 130 patients were studied. Abnormalities in the paranasal sinuses show as high signal on the T2-weighted scans and thus are clearly seen. Abnormalities included mucosal thickening, fluid levels, sinus opacification and retention cysts/polyps. Of the patients studied, 49.2 per cent showed one or more abnormality. Mucosal thickening was the most common abnormality noted and the ethmoid sinuses the most commonly affected.

In a pilot study, EEG changes during odour administration were evaluated by coherence analysis. Ten normal adults were studied. Simultaneous recordings of 16 EEG channels with, and without, odour administration were stored on magnetic tape for further processing. EEG signals were analysed using a signal analyser. Coherence spectra were calculated between all possible channel pairs on the scalp. The amount of data was reduced by extracting broad band coherence values for five frequency bands: delta (2–3.9 Hz), theta (4–7.9 Hz), alpha 1 (8–9.9 Hz), alpha 2 (10–12.9 Hz), and beta 1 (13–17.9 Hz). Coherence values extracted from the control EEG recordings and those during odour administration were compared to evaluate the presence of any significant differences.

The results demonstrated significant changes in the EEG coherence between the two control recordings (control before and control after) in the theta and beta 1 bands. These frequency bands were therefore excluded from the examination. During odorant stimulation with methyl-cyclopentenolone, the coherence in the delta band decreased in the frontal region, while that in the alpha 1 and alpha 2 bands increased in the temporal region. During odorant stimulation with scatol, the coherence in the delta band decreased in the frontal region, while that in the alpha 1 and alpha 2 bands increased between the longitudinal electrode locations. It was suggested that EEG coherence mapping may provide the basis for the development of an objective test of olfactory function in humans.

During the period from April 1974 to March 1993, 357 patients received surgical treatment for papillary and follicular carcinoma of the thyroid gland at the Department of Head and Neck Surgery of National Kyushu Cancer Centre, Japan. In this paper, we review the various clinico-pathological features of these patients and analyse their influence on patient survival. While the majority of the patients' ages ranged from the third through seventh decade, only the patients older than 40 years old died. In papillary carcinomas, there was a statistically significant difference in the survival rate between younger (less than 45 years old) and older (45 years of age or older) patients. The rate of patients who died of thyroid cancer also increased in the cases with extra-thyroidal tumour invasion, and metastasis to distant organs. A multivariate analysis also showed that the age, extrathyroidal invasion and distant metastasis are significant prognostic factors. However, sex, histology and lymph node metastasis were not prognostic factors for survival.

The aetiology of chronic rhinitis and nasal obstruction is often elusive and obscure. Many different causes have been documented including allergens, cigarette smoke, cold dry air, viruses, sulphur dioxide and industrial pollutants. This is the first case we have been able to identify of rhinitis associated with exposure to high levels of lead through indoor pistol shooting.

The genetic aspects of choanal atresia have not been clearly defined though it is probably a multifactorial trait as in cleft lip and cleft palate. The appearance of the condition in both single and successive generations supports this contention.

Choanal atresia can occur as an isolated anomaly, but is more commonly associated with one or more concomitant congenital anomalies. In this report two sisters both in their teens presented with unilateral choanal atresia as an isolated anomaly. Endoscopic trans-nasal repair of choanal atresia was performed in both of them as this offers excellent visualisation and access.

A case of nasal septal perforation secondary to cryoglobulinaemia is reported. In this instance the cryoglobulinaemia was due to Waldenstrom's macroglobulinaemia (lymphoplasmocytic lymphoma with IgM paraprotein) in which the paraprotein was a potent cryoglobulin.

An unusual case of recurrent frontal sinusitis with abscess formation secondary to orbital decompression for Graves' disease is described. The infection was refractory to antibiotics treatment, external drainage and the sinus obliteration procedure. Since the sinus outflow was obstructed by prolapsing tissue following excessive removal of the orbital walls, sinus re-aeration by supporting the prolapsed tissue with a silastic sheet and stenting the sinus drainage tract was attempted. This led to a complete resolution of the infection with an excellent long-term result.

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.

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.

The case of an elderly male with Shy-Drager syndrome is presented. His presentation to the Sleep Clinic for assessment of snoring illustrates bilateral abductor vocal fold palsy as a rare presentation of the syndrome. This case emphasizes the need for thorough investigation of all patients with sleep-related breathing disorders with video and sound recordings prior to anaesthesia and surgery.

The management of oesophageal strictures in neonates and infants is often by bougie dilatation. We report two cases in which balloon dilatation was used successfully and suggest that this may be a preferable technique in this age group.

Acquired tracheo-oesophageal fistulae are uncommon in the paediatric age group. A case of such a fistula secondary to impaction of a button battery is reported below. Prompt management is essential to reduce morbidity and mortality in these cases.

Non-secreting paragangliomas are rare tumours usually present in the head and neck. We describe an unusual case of familial paraganglioma with cranial nerve palsies. After exhaustive investigation, a vagal paraganglioma was found and excised. The positive family history of paraganglioma was of significance, although this was only present in one of five generations. The diagnosis and management of non-secreting paragangliomas is discussed.