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This report describes a patient with permanent hearing loss after spinal anesthesia. The literature is reviewed, particularly concerning incidence and possible causes. The incidence is surprisingly high and related to the size of the needle. The role of the cochlear aqueduct as a transmitter of a decreased fluid pressure in the subarachnoid space to the perilymph of the labyrinth is discussed.

Sinusitis can spread to the orbital tissues. 'Preseptal' soft-tissue bacterial infections are relatively common during childhood and with appropriate antimicrobial therapy they usually resolve quickly. 'Orbital' soft-tissue infections, in contrast, are relatively rare and frequently cause serious morbidity. Four cases are presented. Symptomatology and pathogenesis are reviewed. Diagnostic procedures, especially CT-scan, are discussed and recommendations are given for medical and surgical management.

Two cases of Noonan syndrome are observed. The Noonan syndrome is a Turner-like syndrome with normal chromosomal constitution. Essential criteria in diagnosing the syndrome are the facial expression (hyper-telorisme, low-set and malformed ears, micrognathie, fish-like mouth). The short webbed neck and the cubitus valgus. These children are rather small and mental retardation can be present, especially in comparison with their siblings. Associated cardiac malformations occur in approximately 50% of the cases. We insist on audiologic findings. One case has a hearing impairment due to a malformation of the middle ear, recognised radiologically. The other has a deafness of perception type. Yet, the familial occurrence of last patient makes it doubtful whether this hearing loss can be linked to the Noonan-syndrome.

Overlooking the literature, Wegener's granulomatosis often seems to have manifestations in the ear-nose-throat region, especially in the beginning. The usual clinical findings are mentioned, to put the attention of the ENT-surgeon on this affection. Indeed, by early recognition and proper treatment of this disease, the prognosis is clearly improving. A case-history is illustrating the clinical picture.

A case is presented of mesenchymal chondrosarcoma. This extremely rare tumor has a characteristic histology. The prognosis is poor. Radical surgery is essential. A lifelong follow-up is recommended.

The vestibulometric examination in the ORL office is done by means of the registration of eye movements of vestibular origin, the electro-nystagmography. With the ENG-equipment one can perform electro-oculography, examining eye movements in general. EOG is quite helpful in neurologic diagnosis and important in ORL practice too. The adjustment of the ENG-equipment to EOG is explained, after some words on the physiology and the clinical examination of ocular motor function. Than a short survey is given of the abnormalities that may be met in EOG.

The endoscopical endonasal surgery is in vogue. Today it has become a functional surgery. A thorough knowledge of the endonasal anatomy is difficult but essential. The antral ostium is reached after infundibulotomy, from which starts the inspection of the locoregional pathology.

The white mucus or the opaque mucus lump found in chronic sinusitis may be considered a consequence of hypersecretion, or/of a poor drainage due to ostial dyspermeability, caused by a deficiency of the ciliary system or a modification of the viscosity.

The CT-meato-cisternography with air is at the moment the examination of choice in the diagnosis of the intra-canalicular acoustic neuroma. Every time there is a possibility of acoustic neuroma the air-CT-meato-cisternography has to be performed after the CT-scan was negative. The air-CT-meato-cisternography is easily performed on an outpatient basis and complications are never seen. Filtrated air seems to be the best contrast material.

Injections of "depot" steroid preparations in the nasal mucosa are frequently used for allergic disorders. We felt it would be interesting to study the fate of these injections. Indeed, a microscopic section through the nasal concha shows a tremendous amount of large vessels and it seems possible that a quantity of the injection enters the general blood stream. The difficulties in obraining radioactive cortisone made us choose the red blood cell as a tracer. They have the same dimensions as the cortisone crystals used in the depot preparations, and are a much used tool in a department of nuclear medicine. Mostly they are marked with radioactive chromium. We modified the technique used for the determination of the blood volume by a dilution method. In this technique radioactive blood is injected and the dilution allows for calculation of the whole blood mass. We injected the radioactive blood into the nasal concha and we searched for these radioactive erythrocytes in the circulation. This gave us an idea of the total amount that escaped from the concha. Blood was taken from a patient and marked by the department of nuclear medicine; it was then injected in the concha in the way a depository cortisone preparation is injected, and after several moments blood was taken from an arm vein and the radioactivity measured. Relying upon a normal blood volume in our patient, we were able to calculate the amount that went into the circulation. As the chart shows, there is a very fast increase and after 15 minutes, practically everything was in the blood stream. Thus we conclude: 1. Intra-nasal injections of cortisone are no more useful than intra-muscular ones. 2. Some reactions after this intranasal injections could be explained by the enmasse embolisation of the crystal suspension.

The future of lasers in medicine in general and in otorhinolaryngology in specific appears to be bright. It's use is very simple, but may not weaken the wakefulness of its user. Skill and experience remain very important. The role of the laser is clearly defined. The laser is not the only surgical tool to be used for any given operative procedure.

In treating ear disease every otolaryngologist is familiar with topical medications. The choice of the ideal agent for a given clinical situation may be difficult. In order to make this decision more easy, we overlook the composition of ear-drops. The most important disadvantages are ototoxicity, allergy and pain. The place of ototopical agents in otitis externa, otitis media and otomycosis is discussed.

A case of spontaneous cerebrospinal fluid otorrhea due to a congenital tegmen tympani defect is reported. The etiology and pathogenesis of cerebrospinal fluid otorrhea and of the spontaneous congenital form in particular is discussed, together with the clinical picture and the methods of diagnosis. Reviewing the literature, a middle ear exploration is considered to be the procedure of choice to ascertain the presence and determine the exact locus of the cerebrospinal fluid leak.

Different possibilities of solitary or multinodular involvement of the thyroid gland are described. Because of the broad spectrum of malignancy there exists a controversy and widespread divergence of opinion regarding the incidence, malignancy, classification and treatment of thyroid cancer.

With the development of improved angiographic techniques, arteriovenous meningeal fistulas are being recognized more and more as an important cause of vascular tinnitus. Vascular tinnitus is generally considered to be objective and pulse-synchronous. This report concerns three cases of vascular tinnitus due to arteriovenous meningeal fistulas. They all could not or only hardly be objectified by auscultation and in one of them any pulse-synchronism was denied. The pathophysiology of vascular tinnitus is reviewed, followed by a more detailed discussion about the pathogenesis, the symptomatology and the radioanatomical aspects of arteriovenous meningeal fistulas. Finally, the report deals with the treatment of those fistulas.