Cerebral venous thrombosis is a rare condition affecting predominantly adolescents or young adults. The presentation is often non-specific, and delay in diagnosis is common. The otolaryngologist may be consulted about the radiological findings of lateral sinus thrombosis and mastoid changes. The association of congenital thrombophilia with unusual presentations of venous thrombosis, especially in young individuals is now well documented.

We present a case of lateral and sagittal sinus thrombosis complicated by cerebral venous infarction in a girl with protein C deficiency and masked mastoiditis. Unusual forms of venous thrombosis, including cerebral venous thrombosis may develop in association with a single risk factor for thrombosis, but additional risk factors should be sought especially when thrombosis presents in very young individuals.

This case draws attention to the multi-causal nature of cerebral venous thrombosis in young adults, and highlights the issue of masked mastoiditis. A coordinated approach by otolaryngological and haematological teams is recommended in such cases.

The case report describes the diagnosis and the management of malignant melanoma of the eustachian tube. This is an exceedingly rare condition that was treated with endoscopic surgery and post-operative radiotherapy. During a 15-month follow-up, there was no evidence of recurrence.

The incidence of acute epiglottitis in children has declined with the introduction of the Haemophilus influenzae b vaccine in 1992. We report a case of acute epiglottitis in a child secondary to an immunocompromised state. We suggest that when acute epiglottitis is diagnosed in a child we should ensure there is no underlying predisposing condition.

We present a case of a seven-year-old child with a congenital facial palsy, diagnosed at birth, who subsequently developed a non-tuberculous mycobacterial (NTM) infection of the ipsilateral parotid gland. This required parotid exploration to treat the NTM disease with the intention of identifying and protecting the facial nerve to preserve any residual facial nerve function. At operation, thorough exploration revealed the complete absence of the nerve both at the stylomastoid foramen and more peripherally within the substance of the parotid gland. Exploration of the facial nerve for congenital facial paralysis is not normally indicated. Surgical treatment, if required, tends to involve the use of techniques such as cross facial nerve and free vascularized muscle grafting. To our knowledge this is the first reported case of complete congenital facial nerve agenesis, diagnosed incidentally during a surgical procedure for an unrelated condition.

Although lipomas are the most common benign tumours of the head and neck, the involvement of the skull base is rare and it is also very rare for a lipoma to undergo osseous metaplasia to become an ossifying lipoma or osteolipoma. We present a case of a solitary osteolipoma involving the skull base in a 17-year-old girl. A few cases of osteolipoma involving the head and neck have been reported, but this may be the first reported case of a solitary osteolipoma involving the skull base with extension to the infratemporal fossa and parapharyngeal space. The computed tomography (CT) scan helped to clinch the diagnosis and the histopathology confirmed it. The clinical presentation, role of CT scan, surgical approach used, histological features and the review of literature are discussed.

Respiratory scleroma (often termed ‘rhinoscleroma’) is a chronic inflammatory condition in which deforming masses of tissue distend the nasal cavity. Klebsiella rhinoscleromatis is the causative agent of this infection and the Mikulicz cell is specific to the lesion being a large macrophage with clear cytoplasm containing the bacilli.

Antibiotic therapy has traditionally consisted of streptomycin and tetracycline long-term but this presents problems with adverse side-effects and poor patient compliance.

We report on a young patient with nasal rhinoscleroma who achieved resolution after treatment with oral ciprofloxacin. As mentioned in a review of patients with rhinoscleroma at the Mayo clinic in 1993, the fluoroquinolones deserve further study as potentially highly effective agents for this condition. Ciprofloxacin is convenient for oral administration and has few adverse effects. It achieves good tissue penetration, is concentrated in macrophages and may prove to be useful in the therapy of rhinoscleroma.

We present a case of a patient with an allergy to Merocel nasal tampons and the subsequent complications and implications of this.

Tuberculosis, with its varied presentations and numerous complications, is a relatively common disease in developing countries like India. Amongst its many presentations, pulmonary tuberculosis is the commonest. A tubercular laryngeal abscess is an extremely rare entity. We report a 37-year-old male, diagnosed with a tubercular laryngeal abscess which was successfully treated under local anaesthesia by incision and drainage and in whom a tracheostomy could be avoided.

Sinonasal tuberculosis is a rare disease; its association with osteomyelitis of surrounding bone and cervical lymphadenopathy has been reported rarely. In this article, we report a case of sinonasal tuberculosis that was complicated by osteomyelitis of the ethmoid bone and cervical lymphadenopathy. Infection of the bone was demonstrated by biopsy and 99mTc-MDP bone single photon emission computed tomography (SPECT), and cervical lymphadenopathy was confirmed by histology. This case will be discussed with specific emphasis on the imaging characteristics.

The Arnold-Chiari malformation type I is a rare congenital condition characterized by herniation of the cerebellar tonsils into the upper cervical spinal tract. Various otoneurological manifestations occur in patients with the disease, which has usually been associated with a downbeat type of nystagmus. In this paper a case with this condition is reported presenting with periodic alternating nystagmus (PAN), which is a rare type of nystagmus observed in diseases of the central nervous system of different pathologies. The patient had a complete otoneurological examination and vestibular function testing. Diagnosis was established by using magnetic resonance imaging (MRI).

Myobacterium malmoense is a non-tuberculous mycobacterium that most commonly causes pulmonary infection, particularly in patients with underlying pulmonary disease or immunodeficiency. We describe a case of Mycobacterium malmoense infection of the larynx in a previously well middle-aged woman, which has previously not been reported. The case highlights the importance of considering atypical mycobacterial infection in the differential diagnosis of laryngeal lesions.

A 74-year-old male was referred for the sudden onset of bilateral sudden deafness. The patient had no history of any disease or trauma to the head. Pure tone audiometry revealed bilateral moderate, to severe, sensorineural hearing loss. Auditory brain stem responses (ABRs) showed normal peak and interpeak latencies. These audiological findings suggested that his hearing loss could be attributed to inner ear lesions. However, we felt an alternative explanation for this sudden deafness was likely to exist because the patient also had a month-long fever of unknown origin (FUO) and weight loss of 5 kg/month. Using the criteria of The American College of Rheumatology, we made the diagnosis of polyarteritis nodosa (PAN). Serum MPO-ANCA was positive (× 661).

For treatment, the patient was begun on prednisolone and cyclophosphamide. Nine months later, fever, hypertension, nephritis, pneumonitis, and arthritis had completely resolved, the MPO-ANCA became negative (MPO-ANCA < × 10). Furthermore, his hearing improved.

Laryngeal cleft anomalies are rare congenital defects of the posterior laryngotracheal wall that usually present with a history of recurrent respiratory tract infections during the early neonatal period. Presentation of type I clefts can be subtle and subsequently can result in late diagnosis or indeed failure to present. We report on the case of a type I laryngeal cleft presenting with a history of recurrent lower respiratory tract infections and severe gastro-oesphageal reflux disease, at 19 years of age. This is the oldest documented initial presentation of a congenital laryngeal cleft, and emphasizes the importance of maintaining a suspicion of the diagnosis into early adulthood. We further highlight the role of gastro-oesophageal reflux disease in the presentation of laryngeal clefts.

We report a 60-year-old male who presented to the Otorhinolaryngology department with an acute unilateral sensorineural hearing loss associated with fever and night sweats. The diagnosis of tuberculous meningitis was made. Unilateral sensorineural hearing loss as a presenting symptom of tuberculous meningitis has not been previously reported.

Bilateral extracranial internal carotid aneurysms are very rare, though well documented. We report a case of bilateral extracranial internal carotid aneurysms presenting with vocal fold paralysis, which we believe to be the first.

Inflammatory myofibroblastic tumour (IMT) is a benign pseudoneoplastic proliferation, mainly developing in the lung and extremely rare in the larynx. A patient with a two-month history of dysphonia and a polypoid left true vocal fold tumour is presented. Histological and clinical knowledge of this lesion is important to exclude a misdiagnosis (e.g. malignant epithelial or mesenchymal tumours) and an inappropriate treatment.

Primary amyloidosis localized to the sinonasal tract is extremely rare with only 20 reported cases in the English literature. We describe a further case and review the literature.

Spontaneous temporal meningoencephaloceles are rare entities and diagnostic difficulties can occur. We present two cases whose presentation was atypical and diagnosis delayed by the presence of dual pathology.

Leiomyosarcoma of the larynx is extremely rare. Histological diagnosis for excluding other tumours remains extremely difficult. A rare case of leiomyosarcoma of the larynx, treated by surgery and radiotherapy, is reported. We discuss the clinical presentation, diagnosis, and treatment of leiomysarcoma with a review of the literature.

Eosinophilic angiocentric fibrosis (EAF) is an unusual fibrotic condition affecting the mucosa of the upper respiratory tract, of which there have been eight reported cases. The condition is thought to be associated with the rare skin disorder granuloma faciale, which is histologically identical, and was present in two cases of EAF. We report the third case where EAF and granuloma faciale occurred together, to highlight this type of intranasal fibrosis as a distinct pathological entity.