This article describes the principles which enable a bent septum to be corrected without the loss of tip or supratip support. These principles centre on the need for two points of fixation in order to provide adequate stability for the septal cartilage. These points include the maxillary spine, the vertical plate of the ethmoid bone (at least 4 mm in continuity with the septal cartilage), the vomer, the maxillary crest or suspension from the upper lateral cartilages. A columella pocket offers additional support but cannot be regarded as a primary anchoring point. An adequate height from the maxillary spine to the tip (approximately 28 mm) and dorsal length (24 mm) of cartilage are also needed to support the nasal dorsum. The main strategy for correcting a septal bend which is apparent externally, or a supratip depression is described and centres on the use of cartilage grafts to disguise any assymmetry.

Obliteration of old mastoids and wet middle ears with autologous abdominal fat seems to be a reliable technique to render chronically discharging mastoid cavities or open middle ears dry and closed. This paper is the third in the series and looks at the intermediate results at five years. Of the 16 patients (one bilateral) 94.1 per cent of the ears are still dry and uninfected with closed external meati. Recurrent cholesteatoma was found in two patients at implantation and removed.

Three vestibular nerve specimens removed at transmeatal neurectomy were studied in order to understand better retrograde degeneration and regeneration after vestibular neurectomy in the posterior cranial fossa. In two cases this procedure followed retrolabyrinthine retrosigmoid posterior fossa vestibular neurectomy. The subjects, three patients with Menière's disease, were compared with one another and two autopsy controls with no known otological problem. The specimens were obtained at the distal end of the internal auditory canal and transversely sectioned. Many collapsed Schwann cell basement membranes were observed. The ratio of small-diameter nerve fibres increased significantly after neurectomy. Onion bulb formation around myelinated nerve fibres with small diameters and Schwann cell proliferation around the soma of vestibular ganglion cells reflected remyelination. We conclude that peripheral processes of vestibular nerve fibres can undergo retrograde degeneration and subsequent regeneration after transection of the central process.

Salivary tissue neoplasms may involve normal, accessory and heterotopic salivary gland tissue. A case of Warthin's tumour originating from heterotopic salivary gland tissue of the upper neck is reported. The radioactive uptake of 131I, evidenced in the neck mass in its pre-diagnostic assessment, suggested a diagnosis of cervical node involvement from a primary malignant thyroid neoplasm. A critical review of the literature on heterotopic salivary gland tissue neoplasms of the head and neck is also presented.

In his best poems, the Renaissance poet Sabo Bobljević Glušac emphasizes his hearing impairment, placing his deafness at the centre of attention. These works are not only a poignant expression of an individual artist's suffering, but they may also add to our understanding of the situation of deaf persons. This self-reflection can be seen as a detail that will enhance our ability to communicate with deaf people in order not only to help them hear us, but also to make us hear them as well.

It is well recognized that adenoid hypertrophy and allergic rhinitis are common in children and that recurrent upper respiratory tract infections are a fact of life. The main causes of symptoms associated with rhinosinusitis in children are rhinorrhoea, nasal obstruction, mouth breathing, hyponasal speech and snoring. Most children grow out of adenoid hypertrophy and recurrent colds by the age of eight to 10 and this means that the main treatment strategy should therefore be conservative and not surgical. An explanation to anxious parents, simple non-invasive measures such as teaching nose-blowing, the use of saline sprays or a trial of allergen avoidance and age-appropriate topical nasal anti-inflammatory sprays should be tried before surgery is even contemplated. Because repeated infections are so common, antibiotics given for chronic nasal discharge often have only short-lived effects.

Rhinosinusitis in children is not a surgical disease and ‘watchful waiting’ is advised. Any treatment should first of all be safe, as even without any intervention the problem usually resolves with time. It is likely that growth and maturation of the immunological response to pathogens play a major role in resolution of the disease. There are few exceptions to this principle: nasal polyps (indicating possible cystic fibrosis), and periorbital cellulitis where an assessment of vision, parenteral antibiotics, and if there is concern about the possibility of a subperiosteal abscess, computerized tomography (CT) and drainage of any pus is indicated.

Haemangiopericytoma (HPC) is a rare vascular tumour produced by proliferation of pericytes. One hundred and thirty-three cases of HPC have been reported in the nose and the paranasal sinuses. We present two more cases. Wide surgical excision via lateral rhinotomy, midfacial degloving, or endonasal removal is the treatment of choice. Radiotherapy has been used post-operatively in cases of incomplete removal. Life-long follow-up is required to evaluate local recurrence and late metastases.

This paper discusses the indications for neck dissection in those patients with laryngeal tumours which prove to be, on pathologic examination, not conventional squamous carcinomas but rather fall into the category either of one of the uncommon histological subtypes of carcinoma, or another type of unusual histological variant of laryngeal malignancy, a mesenchymal tumour. It appears as though these unusual laryngeal malignancies may manifest both biological behaviours and propensities to metastasize to regional lymph nodes that differ from those of the more commonly encountered conventional squamous carcinomas of the larynx. This heterogeneous group of tumours accounts for about 10 per cent of all malignant tumours of the larynx.

Three-dimensional images of the incudostapedial joint (I-S joint) were reconstructed using helical computed tomography (CT). The images of the joint were most often reconstructed when threshold values were selected at −500 to −700 Hounsfield Units. These shapes were changed by choosing various threshold values. Histological examinations of the cadaver specimen indicate that these changes are due to structure of the I-S joints. We conclude that these 3-D images may be useful in assessing pathology of the I-S joint.

Alfred Gardiner Brown was the first designated Aural Surgeon to be appointed to the consultant staff of The London Hospital, at the age of 38. In July 1880 he published the paper showing his adaptation of the way in which the tuning fork was applied to the head and its use in measuring hearing power by comparing it with the sense of touch. Had he been blessed with a longer life it is highly probable that he would have made a significant contribution as he was of an innovative and inventive mind. He died at the age of 44.

Isolated congenital anomalies of the ossicles are rare. The majority of cases of congenital conductive hearing loss secondary to middle-ear anomalies have other associated defects, such as atresia, microtia and craniofacial deformities.

We present a rare case of isolated congenital stapes suprastructure fixation, where a monocrural stapes with a mobile footplate was attached to the promontory by bony synostosis. There was no stapedius muscle nor pyramidal process. The incus and malleus were of normal configuration. Mobilization of the stapes from the promontory resulted in improvement in hearing. We believe this is the first reported case of such an abnormality. A review of the world literature of isolated stapes suprastructure ankylosis and the classifications of minor congenital anomalies are discussed.

Patients who, despite treatment, suffer persistent chronic otitis media (COM), a radical cavity and a hearing loss of more than 55 decibels for more than five years, can be classified as having an ‘endstage’ COM. It is generally agreed that retained infected residual cell tracts or a too small meatus are common causes for failure of surgery for COM. Radical revision mastoidectomy (RRM) aims to remove all residual cell tracts in the mastoid, in the middle-ear cleft, around the labyrinth and around the Eustachian tube. The mastoid cavity is obliterated with a pedicled muscle flap. Thus the mastoid cavity is reduced and selfcleansing is improved. The first 16 consecutive patients who underwent a RRM for ‘endstage’ COM were included in this study. In about 80 per cent the treatment resulted in a dry ear. We, therefore, conclude that RRM is an effective and safe method for treating ‘endstage’ COM.

The midfacial degloving approach has been available for twenty five years and is slowly increasing in popularity in the management of extensive benign lesions of the sinonasal region, for selected malignancy in this area and to afford access to the nasopharynx and infra-temporal fossa. The advantages, applications and low complication rate are presented in a cohort of 86 patients, ranging from three to 79 years of age with a mean follow-up of 5.5 years. Seventy-seven per cent of the group had benign pathology of which juvenile angiofibroma was the commonest (40 cases). The 20 cases of malignant disease were a heterogeneous group histopathologically including adenoid cystic carcinoma (four cases), malignant schwannoma (two cases), rhabdomyosarcoma (two cases) and squamous cell carcinoma (two cases). Five underwent bilateral radical maxillectomies combined with orbital clearance in one patient. Complications include oro-antral fistula (three cases) and epiphora (three cases) all of which were successfully treated.

Debate has currently re-emerged following a renewed warning issued from the Committee on the Safety of Medicines (CSM) regarding the relative risk of ototoxicity from the use of aminoglycoside-containing drops in patients with tympanic membrane perforations. We present the findings of a survey of ENT consultants, questioning their views and current practice, and we add to the debate by means of a review and discussion of the literature.