In middle ear surgery via the permeatal approach, aural specula are frequently used to improve visualization of the operative field. Mechanical holders designed for retaining the aural speculum, are expensive and require sterilization for reuse. A simple technique for retaining the speculum which overcomes the drawbacks of a mechanical holder is described.

This paper reports the case of a six-week-old infant who presented with severe rhinitis and upper airway obstruction due to infection with Chlamydia trachomatis.

A case report of a thrombosed posterior-inferior cerebellar artery aneurysm is described. The tumour masqueraded as a vestibular schwannoma on imaging but the presenting featureswere unusual, the facial pain and weakness predominating despite well preserved hearing. This is an example of a rare cerebellopontine angle tumour and highlights the need for suspicion when lesions present atypically.

Maxillary sinus disease can lead to dehiscence of the orbital floor. Using endoscopic sinus surgery it is possible to simultaneously reconstruct the orbital floor and to assess and treat underlying sinus disease.

Haemangiopericytoma is an uncommon vascular tumour that rarely appears in the head and neck region. Such a tumour arising from the middle ear has not been reported since it was first described in 1942 by Stout and Murray. The present case therefore illustrates the first example of a primary middle ear haemangioperictyoma.

Nasal tuberculosis represents a rare manifestation of infection by Mycohacteriurn tuberculosis: a case is presented together with a review of the literature. The correct management is documented, especially the need to treat the patient as if there was a generalized condition, and the problems concerning drug resistance are also considered. The incidence of this disease is rising and its importance must once again he highlighted.

A 47-year-old man developed a complete facial nerve palsy secondary to non-cholesteatomatous suppurative otitis media. At operation, this was seen to be due to destruction of the nerve from halfway along the horizontal segment to a point just distal to the second genu. The history of recent renal transplantation and subsequent immunosuppression was judged to be significant in the pathogenesis of the palsy.

Control and recording of the position of the acoustic rhinometer in relation to the nostrils is important for serial measurements. Several technical factors must be controlled, including the angle of the incident acoustic wave. We describe a simple, newly-designed, rhinometer stand which allows control of height and angle, and hence improves the reliability of serial measurements in clinical and physiological work.

Tuberculoma is a rare but known complication of tuberculosis. It rarely occurs in the mastoid bone. When it occurs in the middle ear cleft, it can lead to intracranial complications if there is a delay in the diagnosis and management.

A rare case of tuberculosis of the middle ear cleft which presented as tuberculoma of the mastoid bone with infranuclear facial palsy is described. The tuberculoma was removed and a canal wall down tympanomastoidectomy was performed. Post-operatively the patient was kept on antituberculous therapy. The various problems encountered in the diagnosis and management of this case are discussed.

Hearing loss and vertigo are uncommon but well-recognized complications of neurosarcoidosis. Until recently the site of the lesion has been debatable and the efficacy of steroids commonly prescribed for this type of hearing loss has been said to be doubtful. A case is presented of sarcoidosis-induced hearing loss in which bilateral VIIIth nerve lesions were demonstrable by MRI with gadolinium enhancement. Treatment with high- dose steroids and azathioprine produced a symptomatic improvement and virtual resolution of the lesions.

A 12-year-old schoolgirl presented with severe obstructive sleep apnoea due to the Robin sequence. The sleep apnoea, together with the associated findings of daytime sleepiness, nocturia, right heart strain and growth retardation, were successfully reversed by nasal CPAP therapy. This therapy allows postponement of a decision concerning corrective surgery until after full growth has occurred.

Since its inception in 1988 the Cochlear Implant Programme in Manchester has successfully implanted 69 adults and 23 children. Of these 92 procedures, three patients have undergone revision surgery with the insertion of either a new implant or re-positioning of the existing device. We examine the circumstances that lead to the need for reimplantation in these patients, discuss the technical aspects of revision surgery together with the functional results of such procedures.

Verbal auditory agnosia implies the failure to recognize sounds in a patient who is nevertheless not deaf. We present a child referred to the ENT outpatients for suspected hearing loss investigation. At one point she had grommets inserted on the basis of a flat tympanogram but with no effect. All hearing tests, including electrocochleography and distraction tests, revealed normal hearing thresholds. At the age of three years and three months, and on direct questioning of the parents, we discovered that the child responded remarkably well to music. Paediatric neurologists made the diagnosis of verbal auditory agnosia. The condition is very similar to another acquired language disorder called Landau-Kleffner syndrome. It is unusual for such a case to present primarily to an ENT surgeon.

Palatal myoclonus is defined as a continuous, rhythmic contraction of the palatal musculature. Reverberant neuronal activity in a region of the brain stem known as the Guillain-Mollaret triangle is believed to underlie this condition.

We present a case of palatal myoclonus which could be abolished, by anterior neck flexion. The pathology and management of this condition is briefly discussed.

Penetrating injury to the larynx is uncommon. We present two cases resulting from the recent Bosnian conflict. It is possible to achieve good laryngeal function by appropriate conservative management once the airway is secured. Progress should be monitored by repeated endoscopic examination and imaging techniques.

Endobronchial tuberculosis is a rare manifestation of pulmonary mycobacterial disease. We present a case in which an endobronchial tuberculous granuloma resulted in acute respiratory distress simulating foreign body aspiration.

Epiglottis prolapse during inspiration is an unusual cause of upper airway obstruction. We present a case of a previously fit. 73-year-old, male with upper airway obstruction secondary to a floppy epiglottis. We describe a simple method of treatment without the need for partial or total excision of the epiglottis or trecheostomy.

We report a case of giant cell tumour of the temporal bone arising in a 31-year-old man. The presenting symptoms were unusual, being rotational vertigo, unilateral tinnitus, and hearing loss. A computed tomography (CT) scan showed a large mass within the right temporal bone and the infratemporal fossa. The radiological appearance was suggestive of an aggressive primary neoplasm arising within bone. Biopsy and subsequent resection showed a giant cell tumour of bone. The tumour was histological grade 1. At two-year follow-up, there was no evidence of tumour recurrence or metastasis.

Traumatic internal carotid artery aneurysm presenting with epistaxis is rare. Epistaxis often occurs after a delay of weeks to months following head injury. The present case had bouts of recurrent massive epistaxis nearly four months after head injury. Diagnosis was made after carotid angiography. Epistaxis ceased after ipsilateral carotid ligation.

Metastatic carcinoma of the ethmoids is very rare. Of the few cases reported in the literature, the majority are renal in origin. Although metastases from the gastrointestinal tract have been reported. there are no known cases of metastases from the stomach.

We present a rare case of metastatic adenocarcinoma of the ethmoids in a patient previously treated for adenocarcinoma of the stomach and describe the possible mechanisms of spread. The patient had a craniofacial resection of the tumour but unfortunately died four weeks post-operatively from acute liver failure probably caused by a liver metastasis.