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The advent of functional endoscopic sinus surgery has created the need for high-quality radiographic images to assess the paranasal sinuses, document the detailed anatomy of the lateral nasal wall and provide an anatomical map allowing safe functional endoscopic sinus surgery. This paper will discuss our experience of 410 paranasal sinus coronal CT scans performed by the technique described by Zinreich prior to consideration of functional endoscopic sinus surgery. The main indications for the scans were acute recurrent sinusitis, abnormal diagnostic nasal endoscopic examination and persistent facial pain. We will consider both the radiological and surgical difficulties that have arisen from the use of this technique and highlight some of the methods to avoid these difficulties. Claustrophobia and limitation of neck movements, particularly in patients over the age of 60, were the most common factors leading to suboptimal scans. Ensuring that the patient was in a symptom-free interval, the differential diagnosis of the opacified paranasal sinus and patients with gross polypoid disease created the most difficulty in interpretation. The anatomical assessment of the frontal recess and the identification of the optic nerve posterolateral to the posterior ethmoidal cell have created the greatest anatomical difficulty.

Three cases of rhinolithiasis are presented in which the diagnosis was facilitated by rigid endoscopic nasal examination. Coronal CT scans were used to delineate accurately the size and site of the rhinoliths. Neutron activation analysis was used in their elemental analysis.

In a series of 410 coronal CT scans performed to assess paranasal sinus disease, we have identified eight cases in which an ethmomaxillary sinus was present. The ethmomaxillary sinus was unilateral in five cases and bilaterally present in three. The sex incidence was equal. Four patients had generalized mucosal disease of their paranasal sinuses which included the ethmomaxillary sinus whereas four patients had osteomeatal complex disease and sparing of their ethmomaxillary sinus. The characteristic radiological features of an ethmomaxillary sinus were drainage into an enlarged superior meatus, reduction in the size of the maxillary sinus and a normal bony orbital cavity. The differential diagnosis of an apparently hypoplastic maxillary sinus is briefly discussed.

During functional endoscopic sinus surgery, the ethmoidal infundibulum and bulla are accessed through the middle meatus. This paper describes a secondary middle turbinate which arises from the lateral wall of the middle meatus, posterosuperior to the infundibulum and points superiorly within the meatus. A secondary middle turbinate was identified bilaterally in 6 out of 400 coronal CT scans of the nasal cavity and paranasal sinuses. The secondary middle turbinate did not obstruct the osteomeatal complex in any of our patients.

The foramen of Huschke, which appears during the embryological development of the tympanic bone, usually closes by the age of five years. A review of 377 dried skulls revealed that the foramen of Huschke was present in adult life in 7% of the skulls examined. A patent foramen of Huschke in the adult may, in rare cases, be the cause of temporomandibular joint herniation or fistulization through the anterior wall of the bony external canal.

Emla cream is a eutectic mixture of lignocaine and prilocaine which can be used to anesthetize the tympanic membrane for myringotomy and ventilation tube insertion. This paper describes the anesthetic method and considers the safety and efficacy of this technique in 37 tympanic membranes from 29 adult patients. All of the patients easily tolerated the procedure. Patients with experience of previous tympanic membrane anesthetic techniques stated a preference for the Emla cream technique. No patient complained postoperatively of vertigo or tinnitus. Pure tone audiometry was performed on all 29 patients in whom a ventilation tube was inserted, both before tube insertion and at review consultation (between one month and 12 months after tube insertion. There was no audiometric evidence of ototoxicity.

Earwax is a mixture of desquamated keratinocytes and hair combined with the secretions of both the ceruminous and the sebaceous glands of the external ear canal. This study analyzed earwax using the combination analytical technique of gas chromatography and mass spectrometry. The major organic components of earwax identified were long chain fatty acids, both saturated and unsaturated, alcohols, squalene and cholesterol. This study demonstrated that it is not currently possible to quantify statistically the substances which constitute earwax with accuracy. The presence of foreign substances within earwax was identified as a complicating factor in the analysis of earwax.