A cohort of 973 consecutive attendants at a rhinology clinic was studied prospectively and divided into patients without facial pain (n = 566, 58 per cent) and patients with facial pain (n = 407, 42 per cent). The prevalence of nasal mucosal contact points was the same in both groups, being four per cent in patients with nasal contact points without facial pain and four per cent in patients with facial pain. A contact point is defined as when contact remains after topical decongestion. Of the 18 patients with facial pain, nine had a spur contacting the lateral nasal wall and nine had a middle turbinate contacting the septum. These 18 patients were followed up for a mean of two years and two months. In the light of their treatment and response the following diagnoses were made: five had tension-type headache, six had midfacial segment pain, one had migraine, two had cluster headache and four had purulent nasal disease. Of the four with unilateral symptoms, two had a contact point on the contralateral side. Eleven of these 18 patients responded to medical treatment for tension-type headache or midfacial segment pain, migraine and cluster headache, three patients were better after surgery for coexistng purulent nasal disease and one patient had a spur removed surgically and remained better at 2 years follow-up, whereas three patients were no better after the same procedure. The results demonstrate that the prevalence of nasal contact points in patients with facial pain is the same as in those within pain. Surgery undertaken to remove mucosal contact points for facial pain is usually unnecessary as the aetiology of this facial pain appears to be a more central processes.

Eosinophilic angiocentric fibrosis (EAF) is a rare inflammatory fibrosing condition of unknown aetiology that involves the nose or larynx producing mucosal thickening and severe obstructive symptoms. We report the first case affecting a male. He presented with nasal obstruction requiring septoplasty. The clinical and histopathological features of the condition are discussed and a comparison is made with the seven previous reported cases.

The effects of packing with ribbon gauze and neuropatties on the nasal mucosa was assessed using sheep as an animal model. Fourteen sheep either underwent ribbon gauze or neuropattie nasal packing. Trauma to nasal mucosa caused by ribbon gauze and neuropatties was compared to mucosa on the lateral aspect of the middle turbinate which was not in contact with any packing. This tissue was used as a control. Ribbon gauze packing resulted in significant loss of 68 per cent of the ciliated surface of the mucosa when compared with the control group with a 15 per cent loss of ciliated surface (p < 0.005). Neuropattie packing also resulted in significant loss of 50 per cent of the ciliated surface of the mucosa when compared with the control group (p < 0.005). There was no significant difference in loss of ciliated mucosa in the specimens packed with ribbon gauze or neuropatties (p = 0.25).

Nasal packing results in a significant mucosal injury with loss of cilia. This may influence the mucociliary clearance of the nose in the post-operative healing phase. Pre-operative nasal packing should be used circumspectly and if possible avoided.

We report eight patients presenting to the Department of Otorhinolaryngology between 1990 and 1998 in whom a diagnosis of sarcoidosis was made. The most common presenting symptom was that of nasal obstruction and crusting and the most common site of involvement was the septum and inferior turbinate. These patients differ from the majority of patients who present with the other manifestations of sarcoidosis in that they are older. Where mucosal changes are present within the nose, biopsy gives a high diagnostic yield. The aim of treatment is to gain symptomatic control with the lowest dose of steroids. The majority of patient's nasal symptoms were managed with local measures and topical steroids. Nasal disease tends to follow a prolonged but benign course. Few had other organ involvement. While nasal sarcoidosis remains a rare cause of nasal obstruction, biopsy of abnormal nasal mucosa along with further investigations as dictated by history, examination and histological findings is important if delay in diagnosis is to be avoided.

The authors compared the acceptance and efficacy of rectal and nasal administration of midazolam (MDZ) for premedication. Ninety-five ASA I and II paediatric patients (8 months to 12 years) scheduled for elective surgery were randomly allocated to two groups. Group R received 0.3 mg kg−1 of rectal midazolam (in 5mL saline). Group N received 0.2 mg kg−1 of nasal midazolam (5 mg ml−1). Both groups were divided in two subgroups according to age (group RA ( ≤ 6 years, n = 33), group RB ( > 6 years, n = 18), group NA ( ≤ 6 years, n = 28), group NB ( > 6 years, n = 16)). At the time of premedication, tolerance to the administration was confirmed. Twenty min after rectal or 10 min after nasal administration the quality of sedation was recorded. The nasal midazolam, in commonly used dosages, induced a sedation similar to that following rectal administration with a shorter delay of onset. Nasal administration was more often painful than rectal administration. Swallowing (nasal midazolam) and concerns about modesty (rectal midazolam) were more frequent in older children. Because of its poor tolerance, nasal premedication should be reversed for cases where there is no alternative. Rectal premedication should be avoided in older children.

A relationship between the reactivity of the nasal mucosa and changes in female sex hormones have been debated for a long time, although no evidence has been presented to prove or disprove this relationship. Nasal patency was therefore measured by nasal expiratory peak-flow in 26 women for two months in order to study changes in nasal mucosal congestion during the menstrual cycle. In another eight women, nasal congestion was measured by acoustic rhinometry, and symptoms of nasal stuffiness were registered during periods when there were various levels of plasma oestradiol and progesterone. Finally, nasal mucosal biopsies were taken for preparation of receptors for oestradiol and progesterone. This study could not verify the effects of female sex hormones on the nasal mucosa. This could be explained by the fact that no receptors for oestradiol and progesterone were found.

Nasal tuberculosis represents a rare manifestation of infection by Mycohacteriurn tuberculosis: a case is presented together with a review of the literature. The correct management is documented, especially the need to treat the patient as if there was a generalized condition, and the problems concerning drug resistance are also considered. The incidence of this disease is rising and its importance must once again he highlighted.

Ninety-five patients undergoing routine nasal surgery were enrolled into a randomized, prospective trial to investigate the efficacy and morbidity of nasal packing. The patients were randomized to receive a bismuth iodoform paraffin paste (BIPP) pack, a Telfa pack or no pack. Patients for septal surgery were randomized between the BIPP and Telfa groups only. They were independently randomized to receive or not receive, a silastic nasal splint for the first post-operative week.

Post-operative pain levels were analysed using a visual analogue scale. Mean pain scores were increased 50 per cent by the use of nasal packs and pack removal, particularly BIPP which, was a most painful event (p<0.001).

Reactionary haemorrhage occurred in only two patients (2.1 per cent), both of whom had packs in situ. Vestibulitis was unique to the patients with a silastic splint, who were packed with BIPP, occurring in 21 per cent of them. Similarly septal perforation was unique to this group. There was no significant difference in the incidence of adhesions between the groups which received packs and those who did not.

Routine nasal packing, especially with BIPP, would seem difficult to justify in view of the increased pain levels and increased complications which occur without any demonstrable benefit in the majority of patients. Therefore packing should be reserved for cases where there is concern about persistent haemorrhage. In these cases Telfa would be preferable to BIPP.

A new instrument is described which relies on suction for the precise removal of polyps and abnormal mucosa during nasal surgery

We present a case of nasal deformity due to sarcoidosis. The surgical management is discussed. The risk of secondary involvement of implanted autologous cartilage by the disease is emphasized. For this reason an inert allograft (silastic) is recommended for augmentation in this group of patients.

Primary atrophic rhinitis seems to have a high prevalence in the arid regions bordering the great deserts of Saudi-Arabia. Fibre-optic endoscopy was performed on 42 patients treated surgically. Fibre-optic endoscopy demonstrated the presence of crusts in the nasal cavities and their subsequent reduction following surgery. It also demonstrated ulceration of the cartilaginous nasal septum in some cases and this may explain the pathogenesis of septal perforation noted in a high number of our patients. Fibre-optic nasendoscopy was also helpful in demonstrating the reappearance of free mucus in the nasal cavity and helped to determine the optimal time for reversing Young's procedure. Fibre-optic nasendoscopy is a reliable tool for verifying the results of surgery and comparing the efficacy of various treatment modalities.

Since good ventilation of the middle ear is a pre-requisite for successful myringoplasty, it was our policy to investigate the tubal function in dry central perforation of the eardrum and to correlate the manometric and endoscopic findings. Nasal endoscopy proved to be indispensable in diagnosing mechanical tubal obstruction and in localizing and even treating ‘hidden’ lesions in key areas, with probable normalization of the tubal function. The correction of the mechanical tubal obstruction must precede ear surgery. Whenever tubal obstruction is diagnosed as functional or idiopathic, the ventilation of the middle ear should be guaranteed during ear surgery by addition of a tympanostomy tube to the graft or drum remnant, and a guarded prognosis given.