Cavernous haemangioma of the parapharyngeal space.

Parapharyngeal space swellings due to various pathological processes have been reported in the literature. We report a case of cavernous haemangioma of the parapharyngeal space in an adult female patient. To the best of our knowledge this is the first such case reported in the English literature.

Occupational rhinitis: a poorly diagnosed condition.

The civil claim of occupational rhinitis may be difficult to prove on the balance of probabilities and is the responsibility of the claimant. There are two types of occupational rhinitis, an allergic rhinitis or a rhinitis due to irritation. Occupational rhinitis can be likened to occupational asthma. Particular attention must be paid to the relationship to alleged exposure and symptoms. Irritation causes symptoms during exposure that cease afterwards unless clinically obvious damage has occurred. Tobacco smoke and nicotine may also cause symptoms. A full examination, both externally and internally of the nose, mouth and eyes should be undertaken. The presence of squamous metaplasia is important. The validity of a claimant's symptoms must be checked against the medical records. Details of all occupations, compounds and protection should be noted. Manufacturing data on the compounds should also be obtained. The Health and Safety Executive publish occupational exposure limits for many industrial chemicals. Allergen-specific IgE may be raised when an allergy is considered to cause the occupational rhinitis. Nasal challenge tests have been used in Scandinavia to diagnose allergic occupational rhinitis. The sense of smell should be tested. There are two approaches, detecting threshold or recognition, which is suprathreshold. When present, three degrees of social effect occur: impairment, disability and handicap. The degree depends on the occupation of the individual.

Recurrent infestation of the mastoid cavity with Caloglyphus berlesei: an occupational hazard.

Mite infestation of the ear is an unusual clinical problem that is easily cured with simple measures and recurrent infestation has not been reported till date. We present here a patient who developed recurrent infestation of otherwise healthy mastoid cavities with the storage mite Caloglyphus berlesei, secondary to occupational exposure. This kind of recurrent mite infestation of the ear has not been described before.

Thermal myringotomy (an alternative to grommet insertion in childhood secretory otitis media?).

Thirty-six children with bilateral secretory otitis media were treated by thermal myringotomy and middle ear aspiration in one ear, and conventional myringotomy, middle ear aspiration and Shepard grommet insertion in the other ear. All children underwent adenoidectomy. Comparing the effectiveness of the two different procedures over a three-month review period, our main findings are as follows. All thermal perforations were closed by 42 days. Elimination of middle ear fluid was achieved in 81 per cent of the thermal myringotomy group, and in 100 per cent of the grommet group. While there was no significant difference in the hearing improvement between the procedures, conventional myringotomy and grommet insertion provided significantly better sustained middle ear ventilation.

Use of bronchoscopic CO2 laser in palliation of obstruction tracheobronchial malignancy.

A review of 15 patients, who underwent 34 CO2 laser bronchoscopic procedures, over a 2-year period, is presented. All had malignancies of the tracheobronchial tree and underwent laser surgery to palliate breathlessness or haemoptysis. Partially obstructing and more proximal tumours proved more easily manageable. One quarter of the patients required repeat procedures and there were two deaths in the early post-operative period. The indications for such surgery, the technique and its limitations, and the palliation obtained are discussed.

Fluctuating hearing loss in presbyacusis.

Thirty-six patients with bilateral symmetrical presbyacusis who reported a temporary improvement in the hearing of one ear following a Valsalva's manoeuvre were further investigated. Bone conduction and air conduction thresholds, middle ear pressure and middle ear compliance were measured before and after Valsalva's manoeuvre in the ears which had a subjective improvement in hearing following auto-inflation. Bone conduction thresholds remained unaltered in 66 per cent of ears while average air conduction thresholds varied by less than 5 decibels. Middle ear pressure was unchanged in over half the ears tested and in 81 per cent of the ears there was no change in middle ear compliance. There appears to be no simple explanation for the temporary subjective fluctuation in hearing reported by patients with presbyacusis.

The management of a neck mass: presenting feature of an asymptomatic head and neck primary malignancy?

Malignancy of the upper aerodigestive tract is not always associated with obvious localizing symptoms. Presentation may then only be prompted by the appearance of a hard mass in the neck, a metastasis to a cervical lymph node. Neck exploration without a prior diligent search for an occult head and neck primary tumour is to be avoided as it compromises subsequent treatment. The diagnostic investigation of 112 patients complaining solely of a painless and enlarging neck swelling is reviewed. An otolaryngologic examination identified an asymptomatic malignancy of the head and neck in 72 patients (64%). Excision biopsy of the neck mass was required to achieve a diagnosis in only 29 (29%) of those patients who had not already undergone surgery. These results are presented to emphasize the need for a specialist examination of the head and neck prior to embarking on excision of any suspicious neck mass.

Neurofibroma of the cervical sympathetic chain presenting with Horner's syndrome.

A case of neurofibroma arising from the cervical sympathetic chain and associated with ipsilateral Horner's syndrome in a patient with von Recklinghausen's disease has been presented. The clinical features and the pathology of the lesion have been discussed.

Pseudolymphoma of the tongue mimicking Hodgkin's disease. (A case report).

We have presented a case of what we believe to be pseudolymphoma arising on the dorsal aspect of the anterior part of the tongue in a middle-aged male with histological features initially suggestive of Hodgkin's disease. The nature and significance of pseudolymphoma have been discussed, together with a critical review of the relevant literature and a suggested outline of management for patients with this type of lesion.