Vasoconstrictor agents are often used to reduce bleeding and hence improvethe operative field in surgery. These agents are potentially dangerous. A trial was undertaken to compare the use of adrenaline 1:80,000 with saline alone as an infiltrating agent in 30 consecutive patients undergoing septoplasty under general anaesthesia. This study, based on a small number of patients can draw no firm conclusions. There are no really dramatic differences between 1:80,000 adrenaline and saline, in terms of blood loss, operative time and the condition of the operative field between the two groups. However, there is a possibility that there are substantial differences, which, because of the variability of these outcomes, could not be detected in a study as small as this. It is recommended that a randomized trial involving patients is used to answer the question.

Scleroma is a chronic specific granulomatous disease endemic in Egypt. The nasal cavities were all affected in the 37 patients examined. The paranasal sinuses and nasopharynx were involved in 17 patients, while the larynx and upper trachea were affected in five patients, four of whom were females. Twenty-three patients were in the granulomatous stage; the rest of the patients were in the atrophic and fibrotic stages.

The main nasal and nasopharyngeal CT findings were soft tissue masses of variable sizes. The lesions were characteristically homogeneous, non-enhancing and had distinct edge definition; adjacent fascial planes were not invaded. The subglottic area was involved in laryngeal and tracheal scleroma. The lesions were mainly in the form of concentric irregular narrowing of the airway. In the trachea, crypt-like irregularities were diagnostic of scleroma. Intra-orbital, intra-cranial and infratemporal parapharyngeal scleromatous masses were detected inone patient.

Previous studies have shown an increased frequency and duration of apnoeic episodes during sleep when the nose is occluded. The aim of this study was to ascertain whether oxygen desaturation occurs with nasal occlusion by postoperative packing. Continuous digital pulse oximetry was carried out before and after submucous resection of the nasal septum in 17 otherwise healthy patients. Post-operative nasal packing produced a statistically significant change in oxygen saturation during sleep. The change was, however, of such small magnitude that it is unlikely to be clinically significant.

Epithelial cells were scraped from the tonsillar surfaces of 15 patients with current acute tonsillitis (AT) and of 15 individually matched healthy persons. The cellular mixture was stained with acridine orange and bacteria seen to be attached to the epithelial cells under the fluorescent microscope were calculated. Conventional bacterial culturing was also performed simultaneously. Significantly more bacteria were attached to epithelial cells from the AT group than from the controls (>10 attached bacteria per cell p = 0.0103, >50 attached bacteria per cell p 0.0212). In vivo determination of bacteria attached to epithelial cells offers prospects of gaining a better understanding of the aetiopathogenesis of acute tonsillitis.

Management of otitis externa and the discharging mastoid cavity accounts for a significant proportion of the ENT out-patient workload. A simple technique of topical application of dermatological preparations is described which is easy and effective.

Cocaine is commonly used in ENT practice for its vasoconstrictor and anaesthetic properties. It is sometimes combined with adrenaline. The laser Doppler Flowmeter was used to compare the effect of 5 per cent concaine alone or with adrenaline (1 in 1,000) on nasal mucosal blood flow.

The results show an average fall in blood flow of 76.7 per cent for cocaine with adrenaline, compared to 61.2 per cent with concaine alone. The difference is significant (P<0.05). The time taken for the blood flow to fall was an average of 131 s and 160 s respectively. These differences are not significant.

A prospective, randomized clinical trial was conducted on 60 patients with confirmed peritonsillar abscess to: (1) compare the safety and efficacy of permucosal needle aspiration with that of incision and drainage; (2) assess whether admission to hospital and treatment with intravenous antibiotics is necessary; (3) culture the pus obtained, in order to decide on a rational antibiotic regime.

Of the 60 patients, 30 were randomized to the needle aspiration group, and 30 to the incision and drainage group. The initial success rate was 87 per cent (26 of 30 patients) with needle aspiration, and 90 per cent (27 of 30 patients) with incision and drainage. Two patients required hospital admission, for rehydration and intravenous antibiotics. The commonest organisms cultured were streptococci (62 per cent); 97 per cent of all patients responded to penicillin. This study indicates that most patients with peritonsillar abscess may successfully and safely be treated by permucosal needle aspiration, and oral penicillin, on an outpatient basis.

We report our experience of submucous resection of the nasal septum under local anaesthesia as an outpatient procedure. We have audited 50 consecutive cases and compared the results with a similar group of patients in whom the operation was carried out in the usual way under general anaesthesia. We have found the procedure to be safe, effective and economically advantageous.

Perforation of the tympanic membrane is a frequent complication of surgery for exostoses of the external auditory canal We report an unusual histopathological finding in a temporal bone containing external canal exostoses which suggests that some of these perforations may be unavoidable.

From a series of 118 fronto-ethmoidal mucocoeles, 40 specimes have been submitted to detained histological analysis. The Frequency of each epithelial and sub-epithelial components is considered and reveals features which support a dynamic theory of bone resorption and formation rather than that of pressure erosion in the pathogenesis of mucocoeles.

One hundred and twenty-six patients who underwent tonsillectomy because of recurrent acute tonsillitis, tonsillar hypertrophy or sleep apnoea were evaluated by tonsillar core culturing. The sleep apnoea patients served as controls, since none of them had tonsillar hypertrophy at ENT examination or any history of recurrent acute tonsillitis, and thus their tonsillar core flora could be regarded as normal.

The isolation rate of H. influenzae was much lower among sleep apnoea controls (2.7 per cent) than among either the patients with recurrent acute tonsillitis (20.3 per cent) or those with tonsillar hypertrophy (36.7 per cent) (p<0.05), as was that of group A streptococci, 5.4 per cent versus16.9 and 20 per cent, respectively (though the latter differences were not statistically significant). The isolation frequencies of B. catarrhalis, pneumococci, group C and G streptococci did not differ between the three groups.

The high tonsillar core recovery rates of H. influenzae and group A streptococci both in patients with recurrent acute tonsillitis and in those with tonsillar hypertrophy, as compared with normal controls, suggests the possible involvement of these bacteria in both conditions.

We report on the use of a little-known instrument for tonsillectomy.

Seventy-three patients with lip carcinoma were treated from 1970 to 1988 inthe Otolaryngology Department of the Beilinson Medical Center. The most common histological type was squamous cell carcinoma which occurred in 68 patients; four tumours were basal cell carcinoma and one acinic cell carcinoma. Carcinoma of the lip is more frequent in males. Nevertheless, the frequency of carcinoma in females in our series was substantially higher than the average reported in the literature. Forty-nine patients were treated surgically and 24 patients were treated by irradiation. Analysis of the results among thosetreated by surgery and those treated by irradiation shows a difference in tumour local control which was statistically significant (p = 0.025). Surgical treatment is recommended because of the advantage of tumour margin assessment, avoidance of radiotherapy complications and rapid rehabilitation. Two rare cases of carcinoma of the lip in young patients (age under 20 years) are presented.

Angiofibromas of the postnasal space are an enigma to the treating surgeon in view of their extensions around the skull base. The availability of modern investigative procedures has to some extent facilitated the decision making process in choosing a suitable surgical approach.

Proper tumour staging and the earliest and widest possible exposure tailored to the needs of the specific situation together with adequate blood replacement is the key to success in minimizing the chances of the recurrence.

The present study aims at an evaluation of the methodology adopted in 100 serial cases of angiofibromas of the postnasal space. After initial surgery, a further 31 procedures were needed for the management of recurrences.

A series of 52 patients were closely assessed prospectively to determine the effectiveness, untoward effects and patient acceptance of a new method of treatment of ‘vasomotor rhinitis’ by silver nitrate application. The patient's age ranged from 11 to 50 years except one who was 58 years old. The report describes the technique used and results obtained following the painting of the ‘trigger area’ of the nasal mucosa in patients with ‘vasomotor rhinitis’. Each patient was evaluated regularly and the evaluation was based on both subjective response and clinical examination. Only cases who had rhinorrhoea and sneezing as presenting symptoms were selected. Silver nitrate (20 per cent) was used after topical anaesthesia, and patients received four applications. Successful relief was obtained in 88.5 per cent (53.0 per cent good relief; 34.6 per cent acceptable relief), while 11.5 per cent of the cases (6 out of 52 cases) had poor relief. No complication was seen among the patients during treatment and follow-up and no silver poisoning was detected.

A 65-year-old woman had suffered for two months from bilateral tinnitus and discharge, pain in the right ear, and loss of hearing. Biopsy showed carcinoma of the squamous type on both sides. Tomography revealed bone destruction on the right. The patient was treated with radiotherapy. Two months after treatment, tomography showed tumour regression on the right side, but progression on the left. The literature on this subject is reviewed.

Diminution of vision following head injuries involving the optic canal is not uncommon. In order to find how a blunt trauma to the frontotemporal region produced damage to the optic nerve inits canalicular this study was conducted on cadaveric skulls and its results are described.

Successful intubation can be accomplished in the majority of patients via direct laryngoscopy. However, situations frequently arise in which simple orotracheal intubation is contraindicated or impossible. In these situations retrograde tracheal intubation may be of particular use. This technique has been performed by novice physicians in cadavers, without difficulty or major complications. It has proved to be a quick, efficient and simple method to establish an endotracheal airway and should be a valuable adjunct for airway control.

A case of myxoma of the external auditory meatus is described. The patient presented with a recurring tumour which had not been correctly diagnosed although the growth had been removed ten times over a period of two years. The tumour was skin covered, contained gelatinous material and was attached to the tympanic membrane and anterior canal wall. Following recognition of the tumour as myxoma, removal was performed with sufficiently wide margins and there has been no recurrence during follow-up for one year.

The aims of this study were: to determine whether there is an increased incidence of iron deficiency in paediatric otolaryngology inpatients compared with other surgical controls; and to establish whether preoperative screening of haemoglobin level is warranted in such patients.

Children aged 1–10 years admitted electively for ENT surgery or for general surgical procedures had blood taken for haemoglobin level, mean cell volume and serum ferritin. Their age, weight, socio-economic class and ethnic background were recorded.

A total of 100 patients entered the study, in a six-month period. The mean ages and weights for the two groups were statistically different, so allowance was made for this in calculations. Social class was not significantly different. No relationship could be established between haemoglobin level and ferritin level for individual patients. Multiple regression analysis for haemoglobin level, mean cell volume and for ferritin level showed that allowing for the age and weight differences these variables were not significantly different for the two groups.

This study has therefore shown no increased incidence of iron deficiency in paediatric ENT inpatients. Each Department should formulate its own policy on pre-operative haemoglobin screening, based on local considerations.