Nasal dermoid sinus cysts (NDSC) are rare congenital lesions that most frequently present in children, but have been reported in adults. This article reviews adult (more than 16 years of age) nasal dermoid sinus cysts as they present, their radiological investigation, surgical approach and outcome. Thirty-eight previously published cases are reviewed, to which a further six cases are added. All 44 cases are tabulated and reviewed. The risk of intracranial extension is 27.5 per cent, especially men with a dermal sinus. Recurrences are likely if the NDSC is not completely excised. Curative treatment is surgical. It is recommended that all adults who present with a dermal cyst and/or sinus in the region of the nasal dorsum should be investigated by computed tomography (CT) and/or magnetic resonance (MRI). This is to delineate deep tissue involvement and to exclude a possible associated intracranial extension, prior to recommending surgical excision.

Balloon dilatation is well established in the management of enteric strictures. The use of this technique in the pharynx has been reported under radiological and endoscopic guidance. We describe the hydrostatic dilatation of a benign pharyngeal stricture in a laryngectomy patient under local anaesthetic, without radiological guidance, in the ENT out-patient department. This procedure was effective and well tolerated in a patient who required regular dilatations.

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Joint Voice clinics run by an ENT surgeon (Laryngologist) and Voice therapist avoid repetition of clinical assessment, better planning of patient management and early initiation of treatment. Although is perceived as optimal management of voice patients it is perhaps not necessary for all patients as it is time consuming for the clinicians involved. The aim of this study was to investigate whether it was possible to identify any subgroup of patients that could potentially be seen in a Voice therapist-led new patient clinic by reviewing the outcome of 96 patients referred to a Joint Voice clinic. Forty-four patients were referred for voice therapy out of which 13 (30%) were teachers or lecturers (total number: 16 (81%)). Two others in this subgroup required medical treatment and the other surgery. The most common aetiology in these professional voice users was muscle tension dysphonia (10 patients, 63%). It is concluded that experienced Voice therapists appropriately trained in laryngostroboscopic assessment could potentially receive and manage direct referrals from primary care physicians. They should however work as part of a multi-professional Voice Disorders Team where the patients could be reviewed by an ENT surgeon if necessary. This would significantly improve the patient pathway for these patients, be cost-effective and make the best use of therapist's and ENT surgeon's time.

Cochlear implantation has become routine in the management of children and adults with profound sensorineural hearing loss. In rare cases postoperative infections necessitate removal of the implant. We present six such cases that have been managed within our programme. Extensive infected granulation tissue was found around the implant at exploration despite prolonged intravenous treatment with appropriate antimicrobial agents. All devices were explanted and three have been reimplanted at our unit. We discuss our management of these cases, the need for explantation, consideration for reimplantation and their functional outcome following reimplantation. We also highlight how systemic inflammatory markers can be unhelpful in detecting significant infection surrounding a cochlear implant.

The administration of anaesthetic gases to an infant undergoing an endolaryngeal laser procedure can be difficult. We describe the use of a Magill's nasal sucker and an anaesthetic connector to maintain anaesthesia during laser surgery.

Cochlear implantation has become routine in the management

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