Acute otitis media and otitis media with effusion (OME) have often been observed in children with bacterial meningitis. OME has also been proposed as the mechanism of reversible hearing loss after meningitis. In this controlled study, children with acute bacterial meningitis were studied using auditory brainstem responses (ABR), otoacousticemissions, tympanometry and otoscopy. An age- and sex- matched control was recruited for each patient and the incidence of acute otitis media and OME was compared between the twogroups. One hundred and twenty-four children with meningitis were studied. Ninety-two children (74 per cent) had meningococcal meningitis. Five patients (4 per cent) had conductive hearing loss (ABR threshold≥30 dB HL) at the time of discharge from hospital. None of the patients or controls had acute otitis media. Patients and controls were well matched for risk factors for OME and the prevalence of middle ear effusion in patients and controls was 7.2 per cent and 11.3 per cent respectively. The relative risk of OME in the children with meningitis was 0.64 (95 per cent confidence interval 0.29 to 1.42). After nine months, three of the five children with meningitis and conductive hearing loss had regained normal hearing.

In contrast to previous reports, there was no relationship between bacterial meningitis and acute otitis media or OME in this study. Nevertheless, coincidental conductive hearing defects were identified as the cause of reversible hearing loss in three patients.

Eighty-five cases with tympanosclerosis of the middle ear were treated surgically in this series from 1984 to 1995. Twelve of them were associated with cholesteatoma and had radical surgery performed. An attempt is made here to classify the tympanosclerosis on a patho-physiological basis. A planned two-stage procedure was performed in 36 cases after an interval of 18 months. The majority of patients had stapes surgery carried out by a two-stage procedure. One of the patients who did not have stapes surgery developed anacusis after 18 months post-operatively and in another patient recurrence was observed. Post-operative hearing improvement was found to be satisfactory in the short-term follow-up period of two to five years. The hearing improvement was analysed by using Chi-square value (x2) and also plotted in the Glasgow Benefit Plot.

Experience with a straight, vertical incision for cochlear implantation in 168 patients of all ages is reported and comparison made with previous experience using a 'C' shaped incision in 173 patients with regard to complications encountered. With the straight incision the only complication was a wound infection which settled in one week; this is in contrast to the 'C'shaped incision, which was associated with a number of serious complications. The straight incision also compared favourably with the other incisions commonly used for cochlear implantation and appears to offer advantages over them.

Among patients who receive cochlear implants, those with Cogan's syndrome make a unique group. On one hand they are part of the post-lingual patients and good results can be anticipated. On the other hand, their basic illness is thought to have an autoimmune aetiology and for that reason more susceptible to complications, especially flap problems. In a series of 60 patients who were implantedat the Sheba Medical Center, three had Cogan's syndrome. No post-operative complications, including flap problems, were observed (followed-up for at least 18 months). Subjective and objective hearing results were very good.

Ten patients with chronic non-allergic rhinitis and presenting mainly with nasal obstruction due to hypertrophied inferior turbinates were subjected to laser turbinectomy using CO2. Tiny biopsies were taken, at the time of surgery as well as one monthlater, and were processed for transmission electron microscopy. The ultrastructural observations included: early epithelial loss which wasfollowed by prompt regeneration of healthy epithelium, decreased number and activity of the seromucinous glands, fibrosis of the connective tissue stroma, as well as diminished number and congestion of the cavernous blood spaces. These observations were discussed in view of the excellent clinical response of the patients.

The ultrastructure of the nasal mucosa following theuse of intranasal levocabastine was studied in 20 patients suffering from perennial allergic rhinitis. The patients received twice daily 0.05 per cent levocabastine spray with a treatment duration of four weeks. At the end of the treatment period regression of the allergic process was evidenced by progressive reappearance of normal cilia and microvilli on the columnar cells, decrease of intercellular oedema andcytoplasmic vacuoles, increased number of mucous acinar cells, gradualdecrease of vascular congestion, as well as diminished oedema fluid formation. The drug, however, had no effect on mast cell degranulationnor on eosinophilic infiltration. Normalization of the ultrastructural features correlated well with clinical improvement.

Considering the results of the present study, levocabastine nasal spray appears to be an effective treatment for perennial allergic rhinitis and can be used with, or as an alternative to, other anti-allergic medications.

Orbital decompression for dysthyroid eye disease is traditionally performed either through an external approach or transantrally. The introduction of endoscopic sinus surgery over the last decade has led to a better understanding of the intranasal surgical landmarks of orbital walls and the development of endoscopic orbital decompression. We have adopted the endoscopic technique as the treatment of choice for orbital decompression in dysthyroid eye disease for the last two years. The surgical technique is described and illustrated, and the results of our first series of 15 patients (30 orbits) are presented.

It has been postulated that the bacteraemia rate following guillotine tonsillectomy is lower than that following dissection tonsillectomy due to intra-operative compression of tonsillar blood vessels by the guillotine. The aim of this study was to evaluate the incidence of bacteraemia following dissection and guillotine tonsillectomy. Sixty-four patients undergoing elective tonsillectomy for recurrent acute tonsillitis were randomly selected, 32 underwent dissection tonsillectomy and 32 guillotine tonsillectomy. Positive intra-operative blood cultures were obtained in 16 patients (25 %), nine (28.1 %) of the dissection group and seven (21.8 %) of the guillotine group. There was no significant difference between the two methods (Chi-squared test, p = 0.77).

The incidence of tracheal stenosis following conventional tracheostomy has been reported as lying between one and 30 per cent. Methods used to assess the degree of stenosis include CT scanning, fibreoptic visualization and plain X-ray tomographs. The aim of this study was to assess the degree of stenosis in patients following percutaneous dilatational tracheostomy (PDT) using MRI scanning. This method has not been reported in the literature previously. Nine patients without symptoms of tracheal stenosis were studied for at least six months following PDT performed in the intensive therapy unit. The tracheas were assessed for scarring and stenosis using a three dimensional volume scanning MRI technique. Although scarring could be detected in the wall of the trachea and subcutaneous tissues of all patients, tracheal stenosis was not demonstrated at the insertion site or at the site of the cuff (p>0.05). MRI scanning provides an excellent non-invasive method of assessing the tracheal lumen. Our patients who had undergone PDT do not appear to have any degree of post-operative stenosis.

Cadaveric temporal bone surgery has previously required the use of the operating microscope. However, in this financial climate, the cost of a microscope can prove prohibitive to many departments. We describe a less expensive, alternative form of magnification and illumination in the temporal bone laboratory.

Aminoglycoside-containing topical preparations are commonly used in the treatment of chronic suppurative otitis media and otitis externa. We report a case where systemic absorption of topical Gentisone HC™ occurred producing a serum gentamicin level of 6.2 μg/ml.

Two cases of metastatic carcinoma of the temporal bone, that simulated glomus tumours on thorough preoperative evaluation are described. Although rare, metastatic spread to this area is recognized, but presentation in this way is unique.

The temporal bone pathology of a 74-year-old female affected by vestibular schwannoma was compared with findings of auditory brainstem response and electrocochleography. At age 71, she complained of hearing loss in the left ear in which pure tone audiometry revealed threshold elevation in the middle- and high-frequency range. Temporal bone CT scanning revealed a medium-sized cerebellopontine angle tumour in the left ear. ABR showed no response in the left ear, but the electrocochleography showed clear compound action potentials. Three years later, at age 74, she died of metastatic lung cancer and sepsis. The left temporal bone pathology consisted primarily of a large vestibular schwannoma occupying the internal auditory meatus. The organ of Corti was well preserved in each turn. In the modiolus, the numbers of spiral ganglion cells and cochlear nerve fibres in each turn were decreased. These histological findings suggest that clear compound action potentials were recorded from the distal portion of the cochlear nerve in spite of the presence of the vestibular schwannoma, but ABR could not be detected because of the blockade of the proximal portion of the cochlear nerve by the vestibular schwannoma.

Differential diagnosis of granulomatous lesions of the nasal mucosa is difficult. One of the possible causes is an infection with Leishmania braziliensis as reported in this case. Therefore leishmaniasis should be included in the differential diagnosis of granulomatous lesions of the nasal mucosa in patients who have travelled to endemic areas.

We present a case of obstructive sleep apnoea in a child that is caused by papillomatosis of the post-nasal space.

We report a case of malakoplakia of the epiglottis in a 45-year-old female patient. Only three cases of laryngeal malakoplakia have been reported in the world literature, one of which was associated with tracheal malakoplakia. To our knowledge this is the first reported case of isolated malakoplakia of the epiglottis. Malakoplakia, a rare granulomatous lesion, has been seen more frequently in the urinary tract. Other organs like the genito-urinary tract, testis, epididymis, lymph nodes, middle ear, nasopharynx, tonsil and retroperitoneal tissue have been also involved though less frequently.

This is a report of two patients with leech inhalation. The first patient presented with severe attacks of inspiratory stridor, cyanosis and cough of five days duration. He had no fever. Indirect laryngoscopy revealed a black, smooth foreign body between the vocal folds. Lateral soft tissue X-ray of the neck revealed shadow involving the glottic and the subglottic areas of the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed and the patient improved.

The second patient presented with difficulty of breathing, dysphagia, and spitting of blood of two weeks duration. Indirect laryngoscopy revealed a brown foreign body in the larynx. Laryngoscopy under general anaesthesia showed a living leech. This was removed by forceps.