Otolaryngological requirements for recreational self-contained underwater breathing apparatus (SCUBA) diving.

Recreational self-contained underwater breathing apparatus (SCUBA) diving continues to grow in popularity. Medical requirements to be 'fit to dive' vary throughout the world, from self-certification to a full medical examination prior to training. This review discusses the relative merits of the most commonly used guidelines for recreational SCUBA diving, with reference to common diving-related otorhinolaryngological conditions. Areas of controversy, such as fitness to dive after rhinological and otological surgery, are discussed. The authors suggest that a unified approach from the various recreational SCUBA diving organizations involved would aid in clarification for divers and physicians alike. The difficulties in achieving such a unified approach, however, should not be underestimated.

Granuloma annulare presenting as multiple nodules on the pinna.

Granuloma annulare is a benign, idiopathic, inflammatory dermatosis characterized clinically by dermal papules and annular plaques. We describe the case of a 40-year-old man who presented with a long history of multiple nodules on the left pinna. Histological examination revealed the typical necrobiotic granulomas of granuloma annulare. The condition predominantly affects the extremities of children and young adults; cases involving the pinna are extremely rare. Nodular lesions are common in otolaryngological practice, and this case illustrates the need for careful clinical assessment and appropriate biopsy in diagnosing lesions of the outer ear

Is aspiration of middle ear effusions prior to ventilation tube insertion really necessary?

A prospective double blind randomized trial of 55 children undergoing myringotomy and insertion of ventilation tubes for bilateral middle ear effusions was undertaken. The aim of the study was to assess the need for clearance of the middle ear by aspiration prior to the insertion of ventilation tubes. The day before surgery the children were assessed by clinical examination, pure tone audiometry and impedance audiometry. At the time of surgery each child underwent bilateral myringotomy, with aspiration of the right or left ear only on a randomly allocated basis. Standard ventilation tubes were then inserted. Postoperative evaluation up to three months following surgery showed no significant differences between the aspirated and the non-aspirated middle ears. We conclude that routine evacuation of the middle ear prior to ventilation tube insertion is not necessary.

Cholesterol granuloma of the maxillary antrum.

A case of cholesterol granuloma of the maxillary antrum is presented, the eighth reported case in the ENT literature. It is postulated that a maxillary antral cholesterol granuloma could be associated with obstruction of the antral ostia, hemorrhage into polypoidal mucosal disease or that an antral cyst may have developed a cholesterol granuloma in its walls as a result of cholesterol precipitation. A review of the literature on cholesterol granuloma suggests that it is a condition which arises in a closed space with poor ventilation or drainage, with long-standing inflammation with effusion or hemorrhage contributing to the formation of free cholesterol crystals derived from tissue or blood breakdown products. The foreign body granuloma produced in this way is then self-perpetuating and requires complete removal for cure rather than a simple drainage procedure.

Investigation of the physiological basis of summating potential changes in endolymphatic hydrops.

An increase in the ratio of the summating potential to the action potential components of the electrocochleogram is known to be a feature of endolymphatic hydrops. We investigated the value of the SP/AP ratio in response to condensation and rarefaction click stimuli delivered separately. In patients with electrophysiological evidence of endolymphatic hydrops there was found to be a significantly greater SP/AP ratio to condensation clicks than rarefaction clicks. This finding supports the hypothesis that the increased SP/AP ratio in hydrops is due to mechanical asymmetry of the basilar membrane.

AIDS: otolaryngological presentation in the high-risk male homosexual.

Since the Acquired Immune Deficiency Syndrome (AIDS) was first recognized in 1981 it has become a subject of increasing clinical importance. Patients with AIDS and related conditions often present with symptoms and signs in the head and neck region. This paper presents the experience of a joint consultation service run between the Departments of Otolaryngology and Venereology at St Mary's Hospital and discusses the clinical features seen in this group of patients. Statistical indicators predict a large increase in the number of cases of AIDS seen in the United Kingdom and the presentation of at-risk patients, particularly homosexuals, to otolaryngologists outside specialized centres is likely to occur with increasing frequency. A knowledge of the modes of presentation and the precautions necessary in undertaking operative treatment of otolaryngological conditions will therefore become mandatory.