Over two-thirds of patients have tried a complementary therapy before seeking conventional medical help. In view of this it is important that doctors keep abreast of developments in this area and of the range of therapies which are now being offered. The interaction between drugs and herbal remedies is one example where this is of particular importance. This review assesses the current evidence base for complementary therapies in nasal disease. Contemporary medicine can learn much from the patient-centred approach that is central to many complementary therapies. There is, as yet, little evidence to support the effect of complementary therapy over those of the placebo effect, cognitive dissonance and the natural resolution of many disease processes.

The available data on the effect of human wet cerumen on bacterial growth are not conclusive. Nevertheless it is widely accepted that cerumen has a bactericidal effect.

In this study the activity of human wet cerumen on bacterial growth was assessed by applying cerumen suspensions to bacterial cultures. Bacterial counts were performed before and after application of cerumen suspensions. A total of 383 assays was carried out with 73 pools of cerumen that were tested against cultures of Staphylococcus aureus, Staphylococcus epidermidis, Corynebacterium spp., Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa and Serratia marcescens.

An increase in growth occurred much more frequently than a decrease in growth in almost every microrganism tested, with the mean increase percentage being much higher than the mean decrease percentage, except in the case of S. aureus.

The largest average growth increase was obtained with E. coli. The largest average decrease in bacterial growth was recorded with S. marcescens.

Our study does not support the conception of a decrease in bacterial growth produced by humen wet cerumen. In vitro, the most observable effect was in fact an increase in microbial growth.

Our study aimed to show whether it is useful to preserve the stapedial muscle during the surgical treatment of otosclerosis. The study was carried out on 67 patients with tympanoscopic evidence of otosclerosis. In group A (34 patients) the stapedial muscle was intra-operatively preserved as follows: the stapedial suprastructure with preserved muscle tendon was transpositioned onto the longer arm of the incus and secured with a wire loop. The mean uncomfortable level for sounds was measured after surgery and the results of group A patients were compared with those obtained in group B (33 patients, who underwent standard surgery). One month after surgery, in group A patients, the cochleostapedial reflex was evoked in 21 patients (61.8 per cent) and two months later in 32 patients (94.1 per cent). One month after operation, in group A patients the mean uncomfortable level was 108.8 dB, while three months later it increased to 114.1 dB. In group B, the relevant values were 97.8 dB one month after surgery, and 98.0.dB three months later. Our presumption that stapedial muscle preservation is necessary has been proved by the fact that the patients with the preserved muscle had a higher noise discomfort threshold.

We investigated the proportion of the cystic form of vestibular schwannoma and assessed the results of surgery in this subtype of the condition. The definition of cystic vestibular schwannomas was based on the following criteria: per-operative identification of cystic components; occurrence of the hypodense/hypointense areas on computed tomography (CT) and/or magnetic resonance (MR); and histological verification of S-100 protein membrane-like structures. In a study of 773 Danish patients with vestibular schwannomas, 44 (5.7 per cent) displayed cystic components. The outcome of surgery on 44 cystic vestibular schwannoma (mean tumour size 39 mm) was evaluated and compared with that for 151 solid grant vestibular schwannoma (mean tumour size 49.8 mm). Per-operatively, we found a substantially higher adherence to different intracranial structures in the solid giant vestibular schwannoma compared with the cystic vestibular (95 per cent vs 70 per cent for brainstem, 91 per cent vs 59 per cent for trigeminal nerve, 85 per cent vs 45 per cent for cranial nerves X and XI, 67 per cent vs 32 per cent for dura). Nevertheless, the preservation of the facial nerve function was much better in patients with solid giant vestibular schwannoma compared with those with cystic vestibular schwannoma (House-Brackmann facial nerve dysfunction grade 6 (one year post-operative): 27 per cent vs 41 per cent, respectively p < 0.04). We conclude that the cystic components in vestibular schwannoma are associated with a less favourable surgical outcome, probably due to the rapid tumour growth and symptoms caused by compression of the posterior fossa structures.

People with learning disabilities are at increased risk of impaired hearing. The aims of this study were to assess the prevalence of hearing impairment and ear disease in people attending the specialist Otolaryngology/Hearing Therapy clinic at the Phoenix NHS Trust, Bristol. The present and future process of such a service was explored. Data were obtained from the referral form and notes made by the consultant otolaryngologist. In 20 months, there were 226 consultations, 188 of which were new referrals. The majority of patients had verbal communication to some extent. Suspected infection/inflammation and unobtainable/abnormal tympanograms, each accounted for 43 per cent of reasons for referral. Twenty per cent of patients were normal otologically. Eighteen per cent were provided with hearing aids and nine per cent required surgery. Ten patients underwent brainstem evoked response testing, half of whom had aidable hearing. Our results are comparable to published data of similar units. It is recommended that combined otolaryngology/specialist hearing therapy services are continued and further developed.

Osteomyelitis of the frontal bone is becoming an increasingly rare complication of frontal sinusitis. We present seven cases that represent the largest series published in the last 50 years. Three cases were associated with intracranial involvement. Osteomyelitis should enter the differential diagnosis when there is a fluctuant swelling on the scalp, or if there is a discharging fistula. Treatment requires aggressive surgery to remove all sequestra in combination with long-term antibiotic therapy. Intracranial complications should be excluded by imaging and treated simultaneously if present.

Oral submucous fibrosis (OSMF) is prevalent in the Indian subcontinent. In a large number of patients conductive deafness due to eustachian tube dysfunction has been found. The present study was, therefore, planned to assess the histopathological changes in palatal and paratubal muscles in oral submucous fibrosis. Incisional biopsy from the soft palate was taken in clinically proven cases of OSMF. In most of the cases, signs of chronic inflammation and fibrosis were seen in the submucosa. Dysplasia was noticed in seven (13.2 per cent) patients. Degenerative changes in palatal/paratubal muscles were found in the form of loss of cross striations in seven (13.2 per cent), oedematous muscle fibres in five (9.4 per cent) and atrophy in five (9.4 per cent) cases. It was concluded that there was definite involvement of palatal and paratubal muscles in OSMF. This could explain the eustachian tube dysfunction in these patients.

Globus pharyngeus as a possible presenting symptom of a pharyngeal or upper oesophageal neoplasm is the main reason why barium swallows are requested, although it is essentially a benign disorder that in many cases requires reassurance only. We therefore retrospectively reviewed all barium swallows done in our department for globus pharyngeus during a one-year period to assess their value in the investigation of this condition. Ninety-two patients were identified. All had a normal ENT examination, and symptoms suggestive of acid reflux was the most common associated complaint, at 11 per cent. Acid reflux (18.5 per cent) and hiatus hernia (12 per cent) were the commonest findings of a barium swallow. Three cases of suspicious findings on barium swallow had a normal examination under general anaesthetic. Statistical analysis showed no significant relationship between the symptoms of globus and the barium swallow results. A barium swallow does not seem to add any further useful information to the investigation of globus pharyngeus. But most globus patients will continue to undergo a barium swallow, because although alternative investigations have been extensively assessed, it is still not clear which is the most appropriate mode of investigation for this condition.

We describe a frontal sinus stent which is cheap, easily produced and effective.

A case is described of an extensive cholesteatoma presenting as a lump on the side of a patient’s head overlying the squamous temporal bone, with erosion of the underlying bone and intracranial extension. The patient was otherwise asymptomatic. This case highlights the bone-eroding capacity of cholesteatoma and the vigilance required in assessing lumps on the head.

A 63-year-old woman had disabling positional vertigo for four months. She showed intense direction-changing apogeotropic nystagmus. Conservative treatment failed to resolve her vertigo. From the findings of the nystagmus, cupulolithiasis of the right lateral canal was suspected. Plugging of this canal successfully eliminated the nystagmus and positional vertigo. Positional vertigo can sometimes be disabling and unresponsive to conservative therapy. Careful analysis of the nystagmus may allow selection of the most appropriate treatment.

The 18q-syndrome is associated with hearing impairment in 50-80 per cent of cases. The hearing loss may be sensorineural or conductive. A high proportion of cases are associated with narrow or stenosed external auditory canals. This may be a useful clinical pointer to the syndrome. Two cases with impaired hearing are presented in this paper including one case with complex external ear and middle ear malformations. The clinical and audiological features in each case are described.

Sarcoidosis affects many different organ systems. However, laryngeal involvement is rare and most cases with laryngeal involvement affect the supraglottis, occasionally secondarily extending to the vocal fold. The features of sarcoidosis in the supraglottic region have been described in several reports, but vocal fold involvement has not been presented in detail. We report an unusual case of laryngeal sarcoidosis initially involving the vocal folds in a 66-year-old man, associated with hypercalcaemia. Our report describes characteristics of the involved vocal folds. Hypercalcaemia is one of the characteristics of sarcoidosis. We concluded that laryngeal sarcoidosis should be added to the differential diagnosis of vocal fold lesions, particularly in patients with hypercalcaemia.

A case of subglottic narrowing caused by an extranodal deposit of sinus histiocytosis in a 29-year-old man is reported. The characteristic features of Rosai-Dorfman disease, such as massive painless cervical lymphadenopathy, fever, raised erythrocyte sedimentation rate and raised white cell count, were all found to be absent. However, typical histological features, such as diffuse lymphoplasmacytic infiltrate, Russel bodies, foamy histiocytes and histiocytes with emperipoiesis, confirmed the diagnosis. Rosai-Dorfman disease is an uncommon disorder and its presentation with progressive subglottic narrowing is extremely rare. Our experience in the management of this condition is reported and the review of literature is discussed.

A candidal abscess is a known complication of disseminated candidiasis, particuarly in immunocompromised patients. We report a second primary growth in the neopharynx brought to light by a candidal abscess in a non-immunocompromised patient.

We present a case of oral ulceration in a patient with essential thrombocythaemia, that proved to be secondary to treatment with hydroxyurea. This complication has not yet been reported in the ENT literature. Hydroxyurea should be considered as a possible cause of persistent oral ulceration in patients with haematological conditions. It should be noted that the onset of this complication is not related to the dose and duration of therapy.