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The aim of this study was to determine which anaesthetic and vasoconstrictor preparations UK Otorhinolaryngologists use for rhinological surgery, with particular reference to cocaine and adrenaline. The incidence and types of adverse reactions to cocaine were also recorded. A postal survey of all BAO-HNS consultant members was performed. Of the 360 consultant surgeons included in the survey, the majority still use peri-operative cocaine on a regular basis, 66 per cent use cocaine and adrenaline together and more than 40 per cent use cocaine in paediatric patients. Sixteen per cent of respondents did not use cocaine. Only 11 per cent of surgeons had experienced cocaine toxicity in their patients, with only one recorded case of mortality. Most surgeons in the UK use cocaine because of the superior operative field it provides and because they consider it to be safe even with adrenaline. The actual incidence of adverse reactions to cocaine is low, with serious complications being less common than the risks from general anaesthesia. Cocaine remains a valuable agent in the armamentarium of the rhinologist.

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The aim of this study was to determine whether neural tissue is present in the bone 'dust' given off during temporal bone drilling. Bone 'dust' from three temporal bone dissections was collected and examined. Evidence of neural tissue was present in two out of the three specimens. Neural tissue is present in the bone dust given off during temporal bone drilling. This poses the question as to the risk of prion transmission during such dissection.

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We present a rare case of a giant intra-parotid calculus in a 64-year-old man with recurrent parotitis. The literature is also reviewed.

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The aim of this prospective study was to determine the suitability of 'direct listing' of patients for tonsillectomy by their General Practitioner. All General Practitioners were issued guidelines outlining the indications and contraindications for direct listing. One hundred consecutive patients, referred over a 6-month period, were screened by an otolaryngologist. Thirty-three of these patients were referred inappropriately. The high rate of inappropriate referrals would suggest that this is an unacceptable practice.

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Impaction of a foreign body in the larynx is a serious event. While inhaled foreign bodies may occasionally impact in the larynx especially in children, a laryngeal foreign body as a complication of percutaneous tracheostomy has not been reported in the literature. We describe the case of a fragment of a Seldinger wire retained in the larynx for two years following a percutaneous tracheostomy and review the literature on the complications of this procedure.

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Benign necrotizing osteitis of the external auditory meatus is a rare condition which occurs in non-diabetic healthy people. The aetiology of the necrotic process with the formation of sequestrum in the bony external meatus is unknown. It is important to differentiate this benign process from malignant otitis externa and radionecrosis of the temporal bone as the management of these conditions differs. We present two cases, one managed surgically and the other medically, and review the literature. Immediate surgical excision of the sequestrum is advocated instead of long-term medical therapy and waiting for it to separate spontaneously.

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The traditional meatoplasty operations performed for chronic otitis externa, which has entered the 'fibrotic' phase, are often unsatisfactory because the results in terms of canal patency, hearing gain and patient satisfaction are variable. Although the use of laser in chronic ear surgery is well recognized, it has not been previously reported as a meatoplasty technique. Ten KTP laser meatoplasty operations were performed on eight patients with chronic otitis externa. This pilot study shows the technique to be effective, fast and with a high patient satisfaction rate in the short-term (mean follow-up period 9.3 months). The average increase in hearing thresholds was 24 dB HL. Significant patient benefit was obtained in at least six out of eight patients using the Belfast rule of thumb. The technique has many advantages over the traditional meatoplasty operations but the long-term results require evaluation.

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OBJECTIVE: To review the clinical features, associated congenital abnormalities, management, and morbidity of infants presenting with posterior laryngeal and laryngotracheal clefts. DESIGN: Case series. SETTING: Great Ormond Street Hospital for Sick Children NHS Trust, London, England. PATIENTS: Consecutive sample of 44 patients presenting with posterior laryngeal and laryngotracheal clefts between December 10, 1979, and January 30, 1992. MAIN OUTCOME MEASURES: Clinical features, incidence of surgery, and associated morbidity and mortality related to different types of airway cleft. RESULTS: The main presenting features were stridor and aspiration, which were more evident with the more extensive clefts. Twenty-five patients (56%) had associated congenital abnormalities. Fourteen patients (32%) were treated conservatively. Sixteen patients (36%) underwent primary endoscopic surgical repair. Eight patients (18%) underwent primary repair via an anterior laryngofissure; and six patients (14%) underwent primary repair via a lateral pharyngotomy. Eight patients (18%) required revision surgery, two (4%) of them on more than one occasion. Ten patients (23%) required fundoplication to control gastroesophageal reflux. Six patients (14%) died. CONCLUSIONS: The identification of an airway cleft requires a high index of suspicion. Morbidity and mortality are reduced by securing the airway, controlling gastroesophageal reflux, and using a multidisciplinary pediatric team. We recommend the anterior laryngofissure because of the ease of surgical access.

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A questionnaire was sent to all Full Members of the British Association of Otolaryngologists to ascertain whether and what type of eye protection surgeons and theatre nurses wear during mastoid surgery. Despite Department of Health recommendations only 58 per cent of surgeons and 19 per cent of theatre nurses routinely wear any form of eye protection.

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In order to investigate the earliest changes at the bone-hydroxyapatite (HA) interface, two materials, dense HA and HA-coated titanium alloy, were investigated for their ability to stimulate production of extracellular matrix both in cell and organ culture. Osteoblast-like cells were obtained from rabbit calvariae after preliminary culture for 3 d and seeded out onto the materials. When these cells were grown in culture on the dense HA no matrix production was seen with the scanning electron microscope after 4 d, but there did appear to be matrix produced on the rougher surface of the HA coating. In contrast, extracellular matrix production was greatly increased in organ culture where the material was placed on a section of bone, particularly on the HA coating, where it formed an organized layer of collagen within 4 d. These results showed that extracellular matrix production by both osteoblastic cells and in calvarial culture was greater on the HA coatings than dense HA. In addition, organ culture allows the investigation of the earliest changes in the bone-HA interface without having to undertake in vivo implantation studies of such short duration.

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The reported incidence of persistent tympanic membrane perforation after the extrusion or removal of Goode-type tympanostomy tubes varies from 3 per cent to 47.5 per cent. A prospective randomized study of 152 Goode-type T-tube removals is presented. In one group of 79 ears, the edge of the defect was just freshened, but in the other 73 ears, the edge was freshened and a small piece of 0.13 mm silastic sheeting placed over the defect. Follow-up was performed at six weeks and three, six and nine months and shows that the use of silastic sheeting increases the rate of closure of the perforation and also significantly decreases the number of persistent perforations at nine months.

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A case of subglottic narrowing caused by an extranodal deposit of sinus histiocytosis in an eight-year-old child with Rosai-Dorfman disease is presented. The airway obstruction was initially managed with a tracheostomy, and then on confirmation of the diagnosis by lymph node biopsy, by excision of the extranodal deposit with a CO2 bronchoscopic laser.

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A case of malignant external otitis is presented. This occurred in a healthy 72-year-old non-diabetic, non-immuno-compromised man after ear syringing. The infection was treated with oral ciprofloxacin for eight weeks with complete resolution.

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A previously unreported association between aniridia and congenital sensorineural deafness is reported in a family in which the father and one child possess the combination of abnormalities. One of the remaining two children also has a congenital sensorineural hearing loss without any occular abnormalities.

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