Following surgical trimming of the inferior turbinates, 32 nostrils were packed with Calcium alginate fibre (Kaltostat 2 gramme fibre packs 80:20 per cent calcium:sodium) for 36–48 hours to achieve haemostasis. There was no bleeding while the packs were in place or after they were removed. These results were compared with two retrospective groups of patients who had undergone the same surgical procedure but the nostrils had been packed with alternative materials.

Antroscopy has been shown to have a role in the diagnosis and treatment of antral disease. Four cases of ‘non-secreting’ benign antral cysts, each presenting with facial pain, were successfully treated using antroscopic techniques. The aetiology and management of these lesions is reviewed with the recommendation that antroscopic removal is the treatment of choice for all symptomatic cases, and for asymptomatic cases in which the diagnosis is in doubt.

IgA nephropathy is an immune complex glomerulonephritis in which examination of the renal biopsy by immu-nofluorescence reveals IgA as the predominant antibody deposited in the glomerular mesangium (Clarkson et al., 1984). It was first described by Berger in 1969. The disease is more common in males and occurs generally during the second or third decades of life (Emancipator et al., 1985). A case of established IgA nephropathy with subsequent onset of sensorineural deafness is described.

The condition of carcinoma arising in a pharyngeal pouch is rare. It has been described in relation to long standing pouches and in pouches previously treated by the Dohlman's operation. Three additional cases of carcinoma of the pharyngeal pouch are described.

A patient developed benign paroxysmal positional vertigo following partial excision of the upper jaw for squamous carcinoma. It is probable that the trauma sustained by the labyrinth during surgery led to the development of vertigo. Benign paroxysmal positional vertigo may be a preventable post-operative complication.

A 64-year-old man had complete excision of an acoustic schwannoma via the translabyrinthine route and the mastoid cavity was packed with fat. Post-operatively there were two episodes of aseptic meningitis and CT scanning demon strated migration of fat into the basal subarachnoid CSF spaces. This unusual complication should be recognized and differentiated from both true infective meningitis and aseptic meningitis from other causes.

The number of elderly patients requiring oncologic head and neck surgery is increasing as this proportion of the population continues to grow. To establish the specific problems and relative risks, 100 patients, 70 years of age and over have been examined to determine post-operative mortality and morbidity. Results do not show these to be significantly increased in the elderly and support an aggressive approach to head and neck cancer management in these patients.

A 60-year-old man presented with a history of progressive sleep disturbance due to an intraoral parapharyngeal salivary gland tumour.

The sleep study performed post-operatively showed rapid resolution of nocturnal hypoxic episodes. This appears to be the first recorded case of a parapharyngeal mass causing sleep apnoea and we review the current literature on obstructive sleep apnoea.

The anti-neutrophil cytoplasmic antibody (A.N.C.A.) test is a solid phase radioimmunoassay which detects autoantibodies specific for Wegener's granulomatosis. The case of a young male is reported with a nasal septal perforation who was extensively investigated revealing no other clinical features, apart from a positive A.N.C.A. test, warranting a diagnosis of Wegener's granulomatosis. It is felt the case represents a false positive A.N.C.A. test and emphasises that the test, whilst useful, should be interpreted in the context of other diagnostic criteria.

We report two cases of massive invasive pituitary adenoma with the unusual presentation of nasal obstruction. In both cases the diagnosis was only made when the obstructing tissue was removed. Cases reported previously have usually presented with severe focal neurological signs or a long history of neurological symptoms. These two cases are unusual in having minimal neurological deficits despite the extension of tumour into the nasopharynx and the middle and posterior cranial fossae. These extensions were well illustrated by computerised tomography. This unusual presentation is discussed with reference to the literature.

A rare case of laryngeal tuberculosis in a 15-month-old Indian child is described. The unusual mode of presentation with stridor, suspicious radiological signs and papillomatus nature of the laryngeal lesion are highlighted.

Clinical assessment of adenoidal enlargement in children is difficult and so the lateral nasopharyngeal radiograph is frequently used to assess both adenoid size and the appearance of the adjacent airways. Various measurements of the soft tissues and airways can be made to assess normality or otherwise. Little previously has been mentioned about the physiological conditions, particularly the mode of respiration, under which these radiographs should be obtained and how changes in these conditions affect their appearance. The marked effect in the appearances of nasopharyngeal soft tissues and palatal airway on simply changing from mouth to nose breathing is presented, and an alternative method of examination, for use under certain circumstances is described.

Malignant change arising in pleomorphic adenoma of the salivary glands is uncommon, with a reported incidence of 2–10 per cent.

Only one case where a pleomorphic adenoma became a clear cell carcinoma appears to have been published in the English literature. An additional case of clear cell carcinoma arising in pleomorphic adenoma of a minor salivary gland is reported and the relevant literature discussed.

A rare case of pharyngeal cyst arising from the second branchial cleft in a 14-year-old boy is described. A cyst located in the right posterolateral wall of the oropharynx was completely removed by an intraoral approach. Histopathological examination revealed that the cyst was lined with columnar (respiratory type) epithelium.

A 67-year-old man with a progressive snoring habit is presented. Fluctuant bilateral abductor vocal cord paralysis was later recognized together with autonomic features suggesting a diagnosis of Shy-Drager syndrome. Snoring as a presenting feature of this condition has been infrequently described. This case highlights the importance of careful assessment of snorers.

Orbital cellulitis is a well recognized complication of paranasal sinusitis. Fearon et al. (1979) reviewed 6,770 cases of sinusitis, of which only 159 had orbital cellulitis. We report a case in which orbital cellulitis progressed to necrosis of the eyelids. This was treated by desloughing and split skin grafting.

Wegener's granulomatosis is difficult to diagnose, especially when the presentation is unusual, restricted to an isolated region. We report four cases of recurrent subglottic stenosis posing difficulty in diagnosis. In each case the finding of anti-neutrophil cytoplasm antibodies (ANCA) strongly suggested an underlying vasculitic pathology, Wegener's granulomatosis. We discuss reasons for the difficulty in diagnosis in the past, the possible role of the ANCA assay in such patients, and suggest it should be more widely used in the future.

Botulinum toxin injection is now recognized as an effective treatment for spasmodic torticollis. Complications of this increasingly popular method of treatment include mild and transient dysphagia, with or without dysphonia, lasting up to four weeks. Two cases of paralysis of vocal cord contralateral to the injected sternomastoid have also been reported. A case of severe dysphagia lasting six weeks associated with ipsilateral vocal cord palsy following botulinum toxin injection is presented. The probable mechanism for these complications is discussed.

Congenital hemifacial hypertrophy is an extremely rare condition. At the time of writing this article, there have been 37 cases reported in the literature. Of these, only two have appeared in the otolaryngologic literature. Cholesteatoma of the external auditory canal (EAC) in hemifacial hypertrophy has not been reported before. This article reports one such case, and discusses the classification of hemihypertrophies. A review of the literature is included in the discussion. Management of cholesteatomas of the external auditory canal is also touched upon. A new theory for the peculiar site selection of cholesteatomas of the external auditory canal is postulated.

This case report describes the clinical course of a patient with Ramsay Hunt Syndrome. Partial recovery of the lower motor neuron facial palsy was associated with decreased hearing and a reduction of the middle ear compliance on voluntary contraction of the facial musculature. It is suggested that this is due to misdirection of regenerating nerve fibres, normally destined for facial muscles, to stapedius muscle.