Giuseppe Gradenigo (1859–1926) was an important figure in the development of Otology. Within this paper the authors consider his background and his particularcontributions to the development of various aspects of audiology.

Prominent ears are the most frequent congenital deformity in the head and neck region. Anatomy of normal and prominent ears as well as the psychological aspects of prominent ears are reviewed. Two types of surgical technique are described with emphasis on the cartilage-sparing technique.

A sound pre-operative analysis, focusing on all partsof the deformity, and surgical techniques which are gradually applied to these deformities should result in pleasing, permanent changes for the vast majority of patients. In our opinion, a combination of cartilage-sparing techniques augmented with cartilage-weakeningprocedures give predictable long-term results with a natural appearing ear and concomitant few, easily treated complications.

The theory that middle-ear effusion (MEE) associated with nasopharyngeal carcinoma (NPC) is merely the result of tensor veli palatinus destruction is deficient because recent studies have shown that many patients with NPC have MEE but no tensor veli palatinus dysfunction. The present study evaluates the relationship between MEE and Eustachian cartilage erosion by NPC and examines the pathogenesis of NPC-associated MEE from a new perspective.

Thirty-five patients with NPC were studied by magnetic resonance scans taken along the lengths of the Eustachian tubes. Twenty-four patients had tumour involvementof both sides of the nasopharynx so that 59 ears were available for study. Eighteen ears had MEE of which 12 had Eustachian cartilage erosion (p<00001, Fischer's Exact Test). In ears with MEE, Eustachian cartilage erosion was frequently but not necessarily associated with tensor veli palatinus destruction.

We postulate that altered Eustachian tubal compliance as a result of cartilage erosion by tumour is an important reason why middle-eareffusions develop in patients with NPC.

Fifteen cases of nasal septal perforation were repaired with a tragal cartilage–temporoparietal and deep temporal fascia sandwich technique using a modification of the approach previously described (Hussain and Kay, 1992). Successful closure was achieved in 14 patients (100 per cent) after an observation time of up to two years. The operative technique and advantages of the modified approach are described.

Twenty-two cases of rhinoscleroma were studied to determine the involvementof the larynx. The study revealed that scieroma affected the larynx in 40 per cent of cases. In the larynx, scleromatous lesions were found in the subglottic region and the disease was observed in stages i.e. atrophic, granulomatous (proliferative i.e. nodular) and afibrotic or sclerotic (scarring) stage as found in the nose. The role of laryngological examination is established in the diagnosis of asymptomatic and early laryngeal lesions and in assessing response to initial treatment. Extensive granulomatous lesions were treated by open excision by the laryngofissure approach which was found to be the best method resulting in a quick recovery without any evidence of subglottic stenosis. The disease as a whole is discussed in the light of available literature.

A lectin histochemistry study was performed in the supraglottic and subglottic regions of 10 hamsters. The submucosal glands were observed by light microscopy. The supraglottic submucosal glands presented numerous mucous tubules but on the other hand, the subglottic submucosal glands had serous tubules which finished at the distal portion in serous acini. The results suggest that the distribution of fucosylatedmucin and serum-type glycloproteins between the supra- and subglottic submucosal glands suggest a different viscosity and function of the mucus.

In spite of previously favourable reports on day-case adenoidectomy, thereare still worries amongst otolaryngologists that such practice is unsafe, especially in arural environment. A national survey was therefore carried out which shows that only 41 per cent of respondents perform adenoidectomy routinely as day-case, and even fewer in rural areas. A regional audit on day-case adenoidectomy, covering five hospitals, was conducted in East Anglia. Between 1994 to 1995, 73 day-case adenoidectomies were performed and the outcome was compared to those of 183 in-patient adenoidectomies during the same period. The children in the day-case group recovered post-operatively even better than the in-patient group. None of them stayed overnight or required re-admission. There was no increased in post-operative consultation to the general practitioner. The parents in the day-case group were mostly in favour of the day-case arrangement (88 per cent). The results suggest that day-case adenoidectomy is safe and popular with parents even in a rural environment.

Tracheoesophageal puncture is an established procedure for voice restoration following laryngectomy. A method using a flexible gastroscope and a percutaneous endoscopic gastrostomy (PEG) set is described. This overcomes a number of problems and complications which may be encountered when using a rigid endoscope.

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) canhave multiple causes. Surgical neck dissections may have an association with this syndrome and represent the basis for this study. A retrospective review of 50 patients undergoing neck dissections was performed to evaluate for the development of hyponatraemia as a consequence of SIADH. Based on the results of this review, a prospective study of 20 consecutive patients undergoing 22 neck dissections was performed to determine the incidence ofSIADH. A control group of 25 consecutive patients undergoing major non-neck dissection surgery was also studied. SIADH developed in nine of 50 patients (18 per cent) of our retrospective group with a high incidence of development in those who had jugular vein ligation (JVL) (22 per cent), pre-operative radiation therapy (25 per cent) or squamous cell cancers (32 per cent). SIADH developed in six patients undergoing 22 neck dissections (27 per cent) in our prospective group. A high incidence was also noted for those with JVL (42 per cent), pre-operative radiation therapy (67 per cent) or squamous cell cancer (40 per cent). No patients developed symptomatic hyponatraemia. No patients in the prospective control group developed SIADH. Neck dissection surgery is associated with a significant risk for the development of SIADH. Factors such as jugular vein ligation (JVL), pre-operative radiotherapy and squamous cell cancer appear to increase this risk.

With improved control of cancer above the clavicles, distant metastases (DM) are frequently more seen and are becoming a more common cause of morbidity and mortality. The present study defined the incidence of distant metastases in a cohort of terminal head and neck cancer patients (HNCP) and compared it to current reported data. The incidence of distant metastases in relation to the primary tumour was evaluated and their impact on survival was assessed. A retrospective survey of patient charts was made, based on the hospice database and original referring hospital charts. Data of 59 patients admitted to the hospice were evaluated. The incidence and location of locoregional and distant disease were studied and effects on survival analyzed.

The overall survival from diagnosis to demise was 42.7 months. Thyroid cancer was seen in 20.3 per cent of cases and squamous cell cancer was seen in 59.3 per cent. Distant metastases were found in 83 per cent and 48.6 per cent of patients respectively. Laryngeal cancer patients had a 54.5 per cent incidence of distant metastases. Locoregional disease was seen in 47 per cent of cases and 35.7 per cent of them had distant metastases while a 64.3 per cent incidence of distant metastases was found in cases without locoregional disease. Mean survival was 47.3 months with distant metastases vs 36.5 months without metastases. The difference was not statistically significant.

The incidence of distant metastases in squamous cell cancer in terminalHNCP was 48.6 per cent. This is the highest reported incidence of metastases in a clinical series. Patients without locoregional disease had almost a two-fold incidence of metastases. Survival was not affected by metastases in this series.

One hundred and ten patients with primary hyperparathyroidism were studied, in which a normal parathyroid gland was found on the same side as an adenoma (both confirmed by histological examination), and the upper or lower location could clearly be defined during surgery. The distribution of the adenomas over the upper and lower glands was unequal: 61.8 per cent in the superior versus 38.2 per cent in the inferior position. Statistical analysis revealed that this is not a random distribution (p = 0.013). The explanation of this relative predilection is unknown. The finding should not influence the surgical procedure for primary hyperparathyroidism

A case of subperiosteal temporal abscess of otitic origin is presented. This is an unusual complication of otitis media. The pathogenesis of Luc's abscess is different from other extracranial complications of middle-ear infections in that it is notassociated with mastoid infection which results in subperiosteal pus formation. Based on our experience and the reports from the turn of the century. we present the presumptive pathogenesis and clinical features. We contend that these patients run an unexpectedly benign course, and require concomitantly more conservative treatment than other otitic abscesses.

We present a child with keratitis, ichthyosis and deafness (KID) syndrome implanted with a Nucleus device. We discuss the wound complications of this child and the steps taken to deal with the problems encountered when the wound failed to heal, followedby the partial extrusion of her implant. Early surgical management involved resuturing the wound but when this failed a rotational flap was required to cover the implant package and allow eventual healing. Despite the wound problems and revision surgery she has a good audiological result.

Transantral ligation of the internal maxillary artery (IMAX) is a well-described option for surgical management of posterior epistaxis not controlled by anterior and posterior packing. Advocates for this procedure argue that it reduces the morbidity, length of hospital stay and financial cost associated with prolonged nasal packing. The procedure is carried out through a Caldwell-Luc approach and the IMAX is clipped in the pterygomaxillary fossa. Fashioning of a nasoantral window is optional and its inclusion usually depends on the integrity of the sinus ostium. The commonest complications of transantral IMAX ligation occur when local structures including the inferior orbital and anterior superior alveolar nerves are damaged. The incidence of oroantral fistula following IMAX ligation is very low but those cases reported have been associated with the failure to create a nasoantral drainage window. We report two cases of persistent oroantral fistula complicating transantral internal maxillary artery ligation. No nasoantral window was fashioned in either of these cases.

We describe two cases of sphenoid sinus mucocoele. Both presented with isolated oculomotor nerve palsy. Mucocoeles involving only the sphenoid sinus are uncommon. They are probably under-diagnosed as they may be asymptomatic or cause non-specific symptoms. Nasal symptoms occur infrequently but the close relationship of the sphenoid sinus to the orbital apex means that ocular symptoms including cranial nerve palsies are a common presenting feature. Involvement of the third cranial nerve in isolation is rare but has important neurosurgical implications which must be excluded before this symptom is attributed to the sphenoid sinus.

Sixty-one cases of bilateral immobile vocal folds were classified as traumatic (52.46 per cent), idiopathic (39.34 per cent) or iatrogenic (8.20 per cent). During follow-up the idiopathic group of patients had a better prognosis (p<O.O5) compared to the traumatic or iatrogenic group. A spontaneous recovery was seen in 58.33 per cent of cases in the idiopathic group, 56.25 per cent in the traumatic group and 40.0 per cent in the iatrogenic group within a period of one year. Patients who failed to show spontaneous recovery were either subjected to arytenoidectomy with fold lateralization, endoscopic fold lateralization or laser cordectomy, showing 70.0 per cent, 66.67 per cent and 80.0 per cent recovery respectively. These cases have been discussed.

Although subglottic cysts have previously been reported as a cause of airway obstruction in the neonate, they have previously been considered to be a relatively rare cause. Cystic narrowing of the subglottis has been associated with endotracheal intuhation. With improving survival of pre-term infants the incidence of the condition could be expected to rise. Prior to 1996, only 58 cases had been reported in the literature. We believe that the true incidence of the condition has been considerably under-reported. Over a six-month period our unit diagnosed five cases of compressible cysts in the subglottis in low birth weight, pre-term infants. All patients underwent diagnostic microlaryngobronchoscopy and vaporization of the cysts by CO2 laser. Three children required more than one procedure. In all cases a satisfactory airway was achieved. The pathogenesis, diagnosis and treatment of the condition is discussed.

Pulmonary oedema is an uncommon but important complication of laryngeal spasm which in turn occurs more commonly in ENT practice than in most other surgical specialities. A case is reported and the literature reviewed, with particular reference to the proposed pathophysiological mechanism of this phenomenon.

Tumours of the sublingual salivary gland are exceptionally rare. The present case report describes an adenoid cystic carcinoma of the sublingual salivary gland occurring in a 16-year-old girl, in itself an uncommon event. In addition, an interesting feature of the presentation was obstruction of the ipsilateral submandibular gland due to involvement of Wharton's duct.