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BACKGROUND: The issues of whether minor surgery should be performed in private or public clinics and/or be funded by the national health service are under continuous debate in Norway. MATERIAL AND METHODS: A prospective study of the benefit of (adeno)tonsillectomies in 120 children is presented. Surgery included in the study was performed on an inpatient as well as an outpatient basis and in public as well as private clinics. RESULTS: There was no difference in patient satisfaction or in the quality of surgery depending on the type of organisation. Relief of symptoms associated with (adeno)tonsillar infections and obstruction following surgery was consistent. Less euresis was found in the study population following surgery. Increased haemoglobin concentration and less protoporfyrin IX in erythrocytes indicate an improved erythropoiesis following (adeno)tonsillectomy. Less manpower was needed to perform (adeno)tonsillectomies in private compared to public clinics. INTERPRETATION: We suggest that the Norwegian national health system opens up for funding surgery of established quality irrespective of whether it is performed in a public or a private clinic.

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Thyroid-associated ophthalmopathy is a local autoimmune reaction in the orbit. Typical signs are retraction of the eyelid, periorbital oedema, proptosis and impaired eye motility. Exposure keratopathy or compression of the optic nerve may be a complication. Patients with severe proptosis or progressive loss of vision need an efficient and safe treatment modality. Immunosuppression may be the first choice, followed by surgical decompression of the orbit. We describe a combined external and endoscopic approach with resection of the lateral, inferior and medial orbital walls. In this way, the increased intraorbital pressure is relieved. Retraction of the upper eyelid is corrected by transconjunctival approach and the release of muscles from the tarsus.

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Interpersonal violence is often initiated by offensive verbal and visual expressions. Physical violence will therefore often be directed towards the face of the opponent. A retrospective analysis of 1,273 maxillofacial fractures at the University Hospital in Tromsø during the period 1987-95 showed a steady occurrence of cases. A prospective study of 162 maxillofacial fractures at Ostfold Central Hospital in 1993 was compared with the material from Tromsø. In both studies half of the patients were young men. Males aged 15-29 years were involved seven to eight times more frequently than the rest of the population. Violence among young men under the influence of alcohol was the predominant cause of the fractures. Young male assault victims often started the fight or actively encouraged it. "Participant" is often a more appropriate term than "victim". Some of those involved relapse into a lifestyle inflicting recurrent maxillofacial fractures. Domestic violence involving females is often disguised as accidents. Alternative methods of solving conflicts should replace the offending behaviour to prevent maxillofacial fractures.

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Leakage of cerebrospinal fluid may occur after fracture of the skull base or after surgery on the skull base, nose, or paranasal sinuses. Further causes of cerebrospinal fluid leakage are tumours and malformations. It may also occur spontaneously. We describe four case reports illustrating diagnostic and surgical problems. Cerebrospinal fluid oto- and rhinorrhoea should be suspected in cases of recurring purulent meningitis. Immunologic demonstration of beta(2)-transferrin in secretions from the nose and ear is a diagnostic sign of cerebrospinal fluid or perilymph. Digital subtraction cisternography, CT cisternography, and flow-sensitive magnetic resonance imaging are sensitive methods for localising dural leakage. Frontal craniotomy has been the traditional surgical approach. The recent involvement of transnasal endoscopic sinus surgery and microsurgery has made it possible to treat cerebrospinal fluid oto- and rhinorrhoea with a high degree of success and less operative morbidity.

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Hereditary hearing impairment affects about 1 in 1000 newborns. In most cases hearing loss is non-syndromic with no other clinical features, while in other families deafness is associated with specific clinical abnormalities. Analysis of large families with non-syndromic and syndromic deafness have been used to identify genes or gene locations that cause hearing impairment. The present report describes a large Norwegian family with autosomal dominant non-syndromic, progressive high tone hearing loss with linkage to 1q21-q23. A maximum LOD score of 7.65 (theta = 0.00) was obtained with the microsatellite marker D1S196. Analysis of recombinant individuals maps the deafness gene (DFNA7) to a 22 cM region between D1S104 and D1S466. The region contains several attractive candidate genes. This report supports the idea of extensive genetic heterogeneity in hereditary hearing impairment and represents the first localization of a deafness gene in a Norwegian family.

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Because of its ability of prevent platelet aggregation, the use of aspirin in Norway is rising abruptly, after some years of fairly low consumption. The author reviews of aspirin-sensitivity, including chronic rhinosinusitis, nasal polyposis and corticosteroid-dependent asthma. Non-steroidal anti-inflammatory drugs have widespread cross-reactions with aspirin, while azo-dyes and food preservatives may induce a similar chronic inflammation of the airways. Why some people develop aspirin-sensitivity is unknown. The basic biochemical mechanisms of aspirin-sensitivity are discussed. Specific treatment based on desensitisation and development of leukotriene receptor antagonists may be rewarding in the future. Possible beneficial or adverse effects of life-long, low-dose use of aspirin on aspirin-sensitivity should be monitored.

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Laryngomalacia is caused by inspiratory collapse of the supraglottic structures in babies. This predominant cause of stridor in the first years of life has a graded occurrence from an insignificant sound phenomenon to insufficient alveolar ventilation with possible serious complications and development of dystrophy. The laryngomalacia must be sub-classified by direct laryngoscopy with a flexible endoscope under spontaneous respiration. Microsurgical techniques for performing supraglottoplasty have recently been introduced. The authors describe symptoms and results in four cases of laryngomalacia, in one of whom a supraglottoplasty was performed. The authors emphasise the importance of recognising laryngomalacia as a possible cause of delayed development in the first year of life.

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We report on a patient with peripheral facial nerve palsy and blurred near vision in association with sulphasalazine treatment. The possibility of this being an adverse reaction to sulphasalazine is discussed.

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Orbital complications from sinusitis are briefly reviewed. Acute orbit is suggested as the common term for all stages in the development. Four patients with acute orbit and ethmoiditis are presented. All had transnasal ethmoidectomy and drainage of the orbit performed by functional endoscopic sinus surgery (FES). Surgical indications are discussed based on clinical signs and CT examination. The operation can easily be staged according to the needs of the individual patient, starting with drainage of the primary cause, the sinusitis. Orbital skin incisions are avoided. Postoperative regression of clinical symptoms has been rapid.

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Mitochondrial disorder is an inborn error of metabolism affecting the cellular respiratory chain. Defective energy production leads to a wide variety of clinical manifestations (ataxia, epilepsy, dementia, myopathy, polyneuropathy, retinal pigment anomalies, and cardiomyopathy with conduction anomalies). Hearing loss is a regular feature and is often the first clinical symptom. Audiologic data from 26 members of a family in three generations is presented. One of these patients was examined for the biochemical error. Respiratory study of muscle biopsy revealed a mild defect in the NADH-ubiquinone oxidoreductase step of the oxidative phosphorylation (complex I). The content of cytochrome aa3 (complex IV) was also reduced. Adult onset sensorineural hearing loss starting in the high frequency region progresses with a fairly constant speed in this family. A cochlear type of hearing loss is found in the less pronounced cases. Advanced cases present features of retrocochlear affection with decreasing speech recognition, elevated acoustic reflex thresholds, and increased ABR latency with derangement of potentials. Caloric sensitivity was unaffected.

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We present an evaluation of our first 217 patients following introduction of functional endoscopic surgery. CT-examination of the paranasal sinuses, together with diagnostic nasoscopy, have greatly improved diagnostic accuracy in sino-nasal diseases. Reestablishment of normal mucociliary drainage is a prerequisite for successful surgery. The majority of patients suffered from nasal polyposis and sinusitis. Drainage of mucoceles and subperiostal orbital abscesses have been performed, as well as resection of bullous middle turbinates. Functional endoscopic nasal surgery reduces morbidity from surgery and therefore, compared with earlier surgical methods, is more cost-effective health economy.

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Two cases of sphenoid sinus mucocele are described. Diagnosis was based on insidious orbital symptoms, apex orbital syndrome, followed by CT and MRI examinations. In one case the mucocele was preceded by seven years of a successfully treated undifferentiated nasopharyngeal carcinoma. Simple transnasal endoscopic drainage of the mucoceles gave good results, although a monocular blindness of long standing was irreversible. A high level of suspicion, combined with modern imaging techniques and prompt surgical intervention, are the prerequisites for avoiding persisting sequelae.

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