The records of 148 adults (aged 14 years and older) presenting previously untreated aural cholesteatomas are analysed with particular emphasis on ossicular destruction and other bony lesions in the middle ear. The findings are compared with those obtained in an earlier study of 63 children (aged 13 years and younger), also with untreated cholesteatomas. The rate of stapes and malleus destruction was similar in adults and children. The rate of incus destruction was significantly higher in adults. Semicircular fistulas as well as facial paralysis were also more prevalent amongst adults. Therefore, the notion of childhood cholesteatoma aggressiveness cannot be related to its effect on these bony structures. It may stem from its higher recurrence rate and from the more troublesome post-operative mastoid cavities, which are often larger in children than in adults.

This study was carried out to validate the enlarged translabyrinthine approach for the surgical management of large vestibular schwannomas. A retrospective review of the charts of 53 patients with large tumours removed via the enlarged translabyrinthine approach at the Gruppo Otologico, Piacenza, Italy, during the last five years was carried out. The ability to control large tumours and the achievement of total removal with low morbidity and very few complications, demonstrate that tumour size does not influence the use of the enlarged translabyrinthine approach for managing large tumours.

Intraoperative facial nerve monitoring has become an integral adjunct in facial nerve identification and preservation for patients undergoing cerebellopontine angle surgery. Since the first description of EMG monitoring of facial nerve activity intraoperatively, many systems have been developed. These systems often rely on unilateral monitoring of the facial nerve with auditory feedback to the surgeon, and it is difficult to distinguish between artifact and significant stimulation of the facial nerve.

In this paper, we present the use of a bilateral, multialarm, facial nerve monitoring system that has multiple advantages over previous systems. Furthermore, we review our experience with this bilateral system, comparing a group of 50 monitored patients to a group of 50 unmonitored patients.

The purpose of this work was to compare pre- and post-operative facial nerve function between unmonitored and monitored cases of skull base lesions. The study involved 32 patients suffering from lateral skull base tumours (10 unmonitored and 22 monitored). Facial nerve function was monitored intraoperatively by an acoustic facial electromyographic system (NIM-2). Post-operative facial function was graded according to the House-Brackmann scale. In the group of monitored cases, facial nerve function was normal (Grade 1 or 2) in 79 per cent of the patients, while the unmonitored patients showed normal function in only 50 per cent of the cases.

These results confirm previous observations that audible evoked electromyographic monitoring significantly reduces permanent facial nerve dysfunction.

Perilymphatic fistula (PLF) remains one of the most challenging problems in otological practice. Fifty-two consecutive patients (53 ears) who underwent explorative tympanotomy for suspected PLF between 1985–1992 were included in this study. The clinical picture, history, patients' complaints and laboratory tests were analysed and compared with the operative findings. The conclusions of our work are that the diagnosis of PLF is based mostly on the clinical picture and a battery of laboratory diagnostic tests, but no one test is truly diagnostic for PLF.

A prospective study was performed to compare Telfa,® paraffin gauze, Merocel® and BIPP used postoperatively following septal or turbinate surgery. Packs were assessed in terms of patient comfort, control of bleeding and ease of removal. There was little to choose between the packs while they were in situ and there was no significant difference in ease of removal. On removal the Telfa® and paraffin gauze were associated with less discomfort and less bleeding than BIPP or Merocel® (p<0.05).

Twenty-five patients who had each had inferior meatal antrostomies performed were endoscopically examined and assessed with acoustic rhinometry six weeks and six months after surgery. No significant increase in nasal cross-sectional area could be demonstrated at the site of the antrostomy in the post-operative cases, although the nasoantral window was found to be patent in 44 of the 50 nasal cavities.

Bilateral transnasal vidian neurectomy was performed on 276 patients between 1983 and 1991. The indications for operation were intractable vasomotor rhinitis, resistant allergic rhinitis and recurrent nasal polyposis. Two hundred and fifty-eight patients were contacted and long-term results showed that 88 per cent of the patients had an excellent result.

The most commonly used incision for parotidectomies is the modified Blair incision. We have successfully used an alternative incision which allows good exposure, and leaves no neck scar.

Between 1 March 1989 and 1 August 1991, 18 parotidectomies were performed using a modified facelift incision. Fifteen parotidectomies were done for similar indications during the same period using a modified Blair incision. The mean age in both groups of patients was 40.3 years. The pathology and incidence of complications was similar in the two groups. The difference in mean (±SD) time of surgery between the two groups was not statistically significant: 3.14 ±0.75 hours in patients with a modified facelift incision and 3.25 ±1.27 hours in patients with a modified Blair incision (p<20.1).

The modified facelift incision is an alternative approach to parotidectomy for selected patients. It provides adequate exposure, even for a total parotidectomy and mastoidectomy and it results in improved patient satisfaction without additional risk of complications.

Abstract The combination of a narrow oesophageal lumen and a hypertonic pharyngo-oesophageal (P-E) segment following laryngectomy and secondary tracheo-oesophageal puncture (TEP) can cause obstruction of a voice prosthesis and consequently prevent phonation. The ‘Allan Johnson’ modification of the Bivona voice prosthesis incorporates a stainless steel slide and has been successfully used to remedy such a circumstance.

A case of spontaneous rupture of the tympanic membrane during anaesthesia is reported and its possible aetiology discussed.

We report the case of a female patient who presented with sudden deafness as the first symptom of a cerebellar tumour which was not localized strictly in the cerebellopontine angle and did not show direct compression on the extrabulbar portion of the Vlllth cranial nerve. The clinical picture contained a number of signs and symptoms typical of cerebellar involvement.

Surgical intervention restored the hearing and caused the symptoms to disappear.

We also review the association between tumours and sudden deafness in the literature.

Recurrent lower motor neurone facial paralysis in successive pregnancies is a rare phenomenon of which there are few case reports in the literature. There have been two previous reports of recurrent Bell's palsy in two and three successive pregnancies respectively, but it is felt that these should have more appropriately been reported as recurrent lower motor neurone facial paralysis in pregnancy as, by definition, any facial paralysis that recurs should not be classified as Bell's palsy even though Bell himself commented on the association between facial paralysis and pregnancy. We report the first case of recurrent lower motor neurone facial paralysis in four successive pregnancies and review the literature.

A child presenting with fever, unilateral nasal discharge and sinusitis was found to have an alkaline disk button battery in the right nostril causing severe mucosal damage and septal perforation. "Nje case is presented and mechanisms of injury discussed.

Chronic inflammation of the skin and mucous membranes following prolonged exposure to high doses of toxic hexavalent chromium is well known in the occupational medical literature. Perforation of the nasal septum is a cardinal clinical feature. Late development of cancer in the respiratory system is established. A recently diagnosed case with an unusually severe affect on the eyes is described. The industrial usage of chromium and its toxiological profile is reviewed.

We present a 68-year-old woman with a vascular leiomyoma of the larynx, a benign tumour that rarely involves that organ. Chief complaints were a feeling of a narrowing of the pharynx and difficulty in breathing in the supine position. A spherical tumour measuring 1.5 cm and covered with normal mucosa was found avthe margin of her epiglottis. The patient was administered a general anaesthetic and the tumour was successfully removed via direct laryngoscopy. Histological examination revealed that the tumour lay beneath a layer of stratified squamous epithelium and was encased in a welldefined fibrous capsule. The tumour parenchyma was composed of proliferated fibres that consisted of elongated cells, surrounded by an abundance of blood vessels. Its complete removal is the treatment of choice with care taken to avoid profuse bleeding. Recurrence is rare.

Extraintestinal involvement of Crohn's disease is becoming more readily identified. Laryngeal involvement by Crohn's disease, however, has been reported in only five cases in the medical literature. We present the sixth case as well as an analysis of the prior reports.

We report myasthenia gravis presenting as dysphagia of acute onset in a 56-year-old female who had no other stigmata of the disease and who was generally well despite rheumatoid arthritis and hypothyroidism. She recovered respiratory function following a general anaesthetic for oesophagoscopy only when antimyasthenic treatment was instituted. She remains well to date. In patients who are known to have autoimmune diseases and who present with dysphagia, features of myasthenia gravis should be specifically sought.

Hydatid disease is an important medical problem in countries of the temperate zones. Only occasional cases are reported in the head and neck region. An unusual location for hydatid disease in the infratemporal fossa is presented. Characteristics of this rare disease together with treatment modalities are discussed.

A case of plasmacytoma arising from the hyoid bone is described, this is a distinctly unusual site, as the marrow-containing flat bones are more commonly affected. On a review of the literature this appears to be the first report of plasmacytoma occurring in the hyoid bone. The patient underwent a CT scan and plain radiographs. Histopathology was diagnostic.