In this paper we present a prospective study of the role of diagnostic sleep nasendoscopy in the investigation and treatment of 20 children referred to a tertiary children's hospital with obstructive awake apnoea or severe obstructive sleep apnoea (apnoea/hypopnoea index greater than 30/h). We describe the technique of diagnostic sleep nasendoscopy and provide a classification system for documenting the findings. We demonstrate sleep nasendoscopy is an invaluable tool in the management of children who continue to have upper airway obstruction despite previous adenotonsillectomy and in children with airway obstruction due to cerebral palsy, syndromes and craniofacial malformations. With the use of pre- and post-intervention sleep studies we have shown that sleep nasendoscopy is accurate in deciding the most appropriate mode of intervention in the individual child with obstructive breathing, from (continuous positive airway pressure) CPAP to site-specific surgery. We conclude that sleep nasendoscopy combined with rigid laryngo-bronchoscopy should be standard practice in the evaluation of children with complex upper airway obstruction.

In this paper we present the first ever reported case of simultaneously occurring bilateral antrochoanal polyps in a fit 12-year-old child. The antrochoanal polyps (ACP) were removed using functional endoscopic sinus surgery (FESS) which achieved complete cure. Histological analysis of the polyps showed them to be of benign inflammatory origin.

Sensorineural hearing loss (SNHL) has been a well-documented complication of sickle cell disease in the literature from West Africa, West Indies, United States of America and the Middle East. We present a study of 52 patients with homozygous sickle cell disease and 36 control patients with haemoglobin genotype AA, matched for age and sex. Seven patients with sickle cell disease (13.5 per cent) were found to have sensorineural hearing loss i.e.>20 dB at two or more frequencies, while all the patients in the control group had normal hearing (p<0.05).Our study shows the incidence of SNHL in the UK to be similar to that reported in the US A and much lower than that found in malaria endemic areas of the tropics.We highlight the factors which we consider responsible for these differences and suggest that the crucial period in the development of SNHL in sickle cell disease may be intra-uterine or during the first few years of life. All sickle cell patients should be encouraged to have regular hearing assessment.

The case of a 75-year-old lady with a large parapharyngeal pleomorphic adenoma excised via a transpalatal peroral technique is presented. This is a new approach to the parapharyngeal space not previously described. A laterally placed full thickness soft palate split from the superior pole of the tonsil to 1 cm proximal to the pterygoid hamulus provided good surgical access to the whole length of the parapharyngeal space and allowed complete tumour excision with minimal morbidity.

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