Congenital cholesteatoma usually presents as either a conductive deafness or as a facial palsy. We report a case which presented as a post-auricular mass. It is important to recognize the possibility that the disease may present in this way when considering the management of such a mass.

A case of primary isolated sphenoiditis that developed cavernous sinus thrombosis is presented. It is difficult to diagnose and patients are often not seen initially by an ENT surgeon, making it more important for other branches of medicine to be aware of this condition. We discuss isolated sphenoiditis with particular reference to the diagnosis, management and complications of this condition

A young girl with objective tinnitus is presented. Using tympanic membrane displacement, the probable origin of the tinnitus has been demonstrated. The patient has responded well to treatment with a tinnitus masker.

Two case reports of HIV positive patients presenting with sudden sensorineural hearing loss are described. The importance of CT scanning and cerebrospinal fluid examination are stressed. The possible aetiology and pathology of the condition are also discussed.

Warthin's tumour (also known as adenolymphoma or papillary cystadenoma lymphomatosum) is benign and accounts for 12 per cent of all neoplasms of the parotid gland. A case of extra-parotid Warthin's tumour occurring synchronously in a peri-parotid lymph node is described. This is not a metastatic phenomenon and occurs as a result of salivary gland inclusions of local lymph nodes during the embryological development of the parotid. Extra-parotid Warthin's tumour should be regarded as a benign incidental finding and the prognosis is excellent.

Two cases of congenital cyst of larynx which is a rare condition, are reported.

Dermoids, or hairy polyps, are rare lesions affecting the head and neck region. To date approximately 120 cases have been recorded. They arise during early embryogenesis and are invariably benign. Unlike the more differentiated types of teratoma, hairy polyps are derived from only two germinal layers, ectoderm and mesoderm. Most originate in the oro-nasopharyngeal region, either as pedunculated or sessile masses. They usually present at, or soon after, birth with signs of upper aerodigestive tract obstruction. Treatment consists of surgical removal. In young children with airway compromise, the expertise of an experienced paediatric anaesthetist is essential.

Three new cases of hairy polyp are described to add to the present literature. Two originated in the nasopharynx and one in the oropharynx. Interestingly, one patient, a neonate, also suffered from severe osteopetrosis. All lesions were removed by simple surgical excision under general anaesthesia. There were no operative or post-operative complications.

From 1968 to 1987, mediastinoscopy was performed on 2021 consecutive patients. The procedure was carried out in 35.7 per cent on patients with a pulmonary infiltrate and in 28.8 per cent with bronchogenic carcinoma. Mediastinoscopy was positive in 54 per cent of the cases. The total number of complications was 2.3 per cent (47/2021). There were four cases with major haemorrhage, three tracheal ruptures and three wound infections. Recurrent nerve paralysis was verified in three patients and pericardial rupture in two patients. The total of major complications was 0.5 per cent (10/2021). There was no deaths in this series. In the authors' opinion, mediastinoscopy can be regarded as an effective and safe procedure in the hands of an experienced surgeon.

Angiosarcoma (malignant haemangioendothelioma) of the nasal cavity and paranasal sinuses is extremely rare. Only a few cases have been reported in literature. A case of angiosarcoma of the nasal cavity and maxillary antrum in a 38-year-old male patient is reported. He was treated with pre-operative external radiotherapy followed by wide excision of the tumour. He currently remains free of the disease 10 months after diagnosis (and seven months after completing therapy).

A columellaform stapes found in male patient 18 years old with a conductive hearing loss, has been examined by SEM and light microscopy. The ossicle was smaller than a normal stapes. The head was linked to the base by a crural plate, probably formed by the fusion of the material of the two crura. Microscopy showed a slightly less interwoven structure of the fibrillar bone present mainly at the cranial aspect of the crural plate. Honeycomb-like bone was confined to the caudal part of the crural plate. Microscopy revealed a cavity in the centre of the stapes at the transition between the base and the plate. During surgery, a bony structure was found linking the posterior side of the head of the stapes to the pyramidal eminence. Post-operative audiograms revealed improved hearing with some residual conductive loss of about 10 dB. This case illustrates that a columellaform stapes may occur without forming part of a syndrome.

Thyroglossal duct cysts most frequently present in childhood as a painless midline swelling of the neck. Uncommonly, these embryonal remnant cysts present clinically in adult life. The majority of adults with thyroglossal duct cysts present with a swelling at the level of the thyrohyoid membrane. On rare occasions, a thyroglossal duct cyst can present with more sinister symptoms, such as hoarseness, dysphagia and dyspnoea. On these occasions, the pre-operative clinical and investigative diagnosis remains in doubt until histology is available.

A 46-year-old male was admitted to an intensive care unit: for 11 days he was ventilated via a naso-tracheal tube. Because of excess tracheal secretions, a mini tracheotomy was attempted on the unit which resulted in profuse arterial haemorrhage, necessitating immediate reintubation and subsequent formal tracheostomy. The authors feel that this complication was due to a mid-line vertical incision and that this could have been avoided by a horizontal incision across the lower part of the cricothyroid membrane, as close to the cricoid cartilage as possible. They describe their recommended technique.

This report adds 16 myoepitheliomas of salivary glands to the 47 already recorded in the literature. It includes, for the first time, a flow cytometric analysis of their ploidy (DNA content) and proliferative capacity (S-phase fraction). Thirteen myoepitheliomas were diploid; three were aneuploid in their DNA content. A high proliferative capacity was always associated with an abnormal DNA content. Only one diploid myoepithelioma had a high S-phase fraction. Both flow-cytometric parameters are good predictors of an aggressive biological behaviour. Recurrences, however, were all the outcome of incomplete primary removal of the myoepitheliomas. Four of the twelve (33 per cent) diploid myoepitheliomas recurred and one, with high S-phase fraction, led to the death of the patient. Two of the three (67 per cent) aneuploid myoepitheliomas recurred. Extensive loco-regional invasion by one killed the patient. The other has clinical evidence of distant metastasis.

Verrucous carcinoma is a rare type of squamous cell carcinoma which is most often seen in the oral cavity and larynx. This paper describes a case of verrucous carcinoma of the maxillary antrum, a site in which this tumour has been described on only two previous occasions in the English language literature.

A case of superficial epithelioid schwannoma is presented. The lesion arose as a skin papule in the infra-orbital region and recurring repeatedly over a five-year period, caused significant local morbidity without metastasis. Radical surgery was delayed in the hope of preserving binocular vision. The similarity of this tumour with a rare variant of malignant melanoma, the neurotropic melanoma, is discussed.

Three cases of acute, non-suppurative otitis media in adults are described. They are unusual in that the effusion was confined to the upper middle ear, whilst the lower middle ear was aerated. The aetiology of such localized effusions, is probably related to the anatomy of the middle ear compartments, the mucosal folds forming them and the apertures allowing communication between them. The compartments are relatively constant and are a result of the embryological development of the middle ear. The localization of these effusions, demonstrates the segmental anatomy of the middle ear.

A case of renal carcinoma metastatic to the left parotid gland is presented. A 60-year-old male patient developed a painful mass in his left parotid region one and a half years after he had undergone a left nephrectomy operation for renal carcinoma. The mass was excised surgically. The histopathological diagnosis was metastatic renal carcinoma. From a review of the literature, it is apparent that unlike most of the cases reported, this one had a very aggressive nature. The clinical presentation of the metastasis, and the factors determining the prognosis in cases of metastatic renal carcinoma to the head and neck are discussed.