A spacer device was modified to deliver aerosols of beclomethasone diproprionate, ipratropium and bromide sal-butamol, to an asthmatic child with a tracheostomy, where symptoms were poorly controlled with nebulized therapy. This resulted in a marked improvement in symptoms and a dramatic reduction in the time spent administering drugs.

A 53-year-old female patient who presented with recurrent meningitis as a result of a meningioma, is reported. The meningioma was found to be wholly contained within the left mastoid antrum. To our knowledge this is the first reported case of a meningioma localised to the mastoid antrum. The patient had been assessed in the ENT department on two separate occasions, 17 years and 19 years previously for nebulous symptoms related to the left ear which had cleared spontaneously. Following a second episode of pyogenic meningitis, both of which were associated with aural symptoms, radiological examination suggested an intramastoid pathology which prompted mastoid exploration. Histological examination of the mass confined to the mastoid antum provided the diagnosis of meningioma. There was no clinical or radiological evidence of extratemporal spread of tumour.

An inflatable balloon was inserted through a pre-existing tracheostomy to occlude the upper trachea. This technique controlled previously intractable laryngeal overspill for a period of three months in a patient with inoperable carcinoma of the larynx.

Benign tracheal tumours are uncommon in adults and rare in children. According to several extensive reviews, fibromas are the second most common benign tumour to occur in the trachea. (Gilbert et al., 1949, 1953).

In our review of the literature, 197 adult cases of fibromas have been reported and 23 in children. However only one previous report of a congenital subglottic fibroma exists. (Tsui and Lore 1975). No previous case with a late onset vocal cord palsy has been reported.

Variability in the size of the dural sinuses and jugular bulb is not uncommon and usually manifests as a high jugular bulb encroaching upon the floor of the middle ear. A rarer entity is the superior and medial extension of the jugular bulb into the bone of the posterior wall of the internal auditory meatus. We report a case where this anomaly was encountered during acoustic neuroma surgery making exposure of the fundus of the internal auditory meatus technically impossible. The possibility of a communication with the superior petrosal sinus is discussed.

We describe the fourth case of aggressive fibromatosis of the larynx arising in an adult. Most cases of laryngeal fibromatosis have been described in children. In the larynx it may behave the same as in other sites, with local aggressiveness but without metastatis. The possible differential diagnoses are discussed.

Idiopathic fibrosis of different areas of the body such as retroperitoneal fibrosis, mediastinal fibrosis, sclerosing cholangitis, Reidel's thyroiditis and pseudo-tumour of the orbit are well recognised entities that manifest individually or in combination. A case of idiopathic fibrosis of the upper aerodigestive tract is presented, which caused dense fibrosis of the floor of mouth, tongue, pharynx and larynx leading to aphonia and severe dysphagia. A permanent tracheostomy was performed and regular bouginage is necessary. This is the first such case reported in the literature.

Lipomata are the most common benign tumour of the head and neck. They may undergo a variety of changes, one of which is ossification which, although rarely seen, has a characteristic radiographic appearance. We present a case of a retropharyngeal lipoma which demonstrates ossification and discuss the features which differentiate this from an osseous lipoma. Current theories on the aetiology of lipomata and their ossification are reviewed.

A case of an aggressive supraglottic squamous cell carcinoma, which was managed with neo-adjuvant chemotherapy and radical surgery, is described. The post-operative course was of rapid deterioration and death due to progressive metastatic disease involving bone marrow and liver. This is the first reported case of bone marrow infiltration by squamous cell carcinoma of the head and neck diagnosed ante-mortem. The incidence and pattern of metastatic disease from head and neck tumours is reviewed, and the importance of initial staging in determining the risk of distant metastatic disease is emphasised.