Background: Pregnancy-induced rhinitis (PIR) is often misclassified and under-diagnosed. There is currently no cure or optimum symptomatic treatment. Objective: To summarize current knowledge of PIR and assess evidence supporting treatment options. Type of review: Structured literature search. SEARCH STRATEGY AND EVALUATION METHOD: Review of English-language articles addressing evidence for aetiology, classification, differential diagnosis or treatment options for PIR. Comparisons to management of other types of rhinitis in pregnancy are also considered. Results: Incidence and prevalence of PIR vary widely between studies. Hormonal changes have a presumed aetiological role, although present evidence is scanty. Smoking appears to be the only agreed identifiable risk factor. Distinction between PIR and other types of rhinitis in pregnancy, especially allergic rhinitis, is important as effective treatments differ. Management of PIR focuses on minimal intervention required for symptom relief. Conclusions: Although PIR is temporary, its impact on patients` quality of life can be profound. Advice and conservative treatment provide the mainstay of clinical management. None of the currently available medical options offer an ideal solution. Any potential benefit gained should be balanced against risks to the foetus. Clarifying the definition of this separate category of rhinitis will lead to better recognition, with prompt and appropriate treatment.

A family is presented with autosomal dominant progressive palmoplantar hyperkeratosis, which is invariably associated with a slowly progressive, bilateral, high frequency, sensorineural hearing loss. The family show no other ectodermal abnormality. The differential diagnosis and possible mechanisms are discussed. This family appears to represent a unique variant in the hyperkeratosis-deafness association.The association between hearing loss and various dermatological conditions has been well described.' The combination of sensorineural hearing loss (SNHL) and palmoplantar hyperkeratosis has also been recognised.26 However, previous reports include evidence of widespread ectodermal dysplasia (pili torti, dental anomalies, alopecia, nail dystrophy), or a variable relationship between the inheritance of skin changes and hearing loss. We present a family with characteristic, progressive palmoplantar hyperkeratosis invariably associated with a progressive, high frequency, sensorineural hearing loss, but without evidence of other ectodermal abnormality.Family history The 4 year old proband presented at 18 months of age with a suspected hearing loss. The initial impression was one of serous otitis media. Subsequent audiometric assessment confirmed a bilateral, high frequency SNHL,

A concise and thorough approach to assessment in the general ENT clinic will provide the diagnosis and facilitate the management of the hoarse voice in the majority of cases. Voice therapy is an important tool that should be utilised in the general ENT clinic and should not be restricted to the specialist voice clinic. If there is no improvement after initial measures, the larynx appears normal and/or the patient has failed initial speech & language therapy, referral to a specialist voice clinic may be helpful. More research is still required particularly with regard to laryngopharyngeal reflux which is often cited as an important cause of hoarseness but is still poorly understood.

This study aims to provide guidance regarding patient selection and timing of intervention with sphenopalatine artery (SPA) ligation by defining 'severe epistaxis'. An analysis of all patients undergoing SPA ligation (January 2002-2010) was performed. SPA ligation was deemed necessary if at least one of the four identified criteria was fulfilled. The same analysis was also performed on all patients admitted with epistaxis who did not undergo SPA ligation over a 6-month period. All 27 patients who underwent SPA ligation met at least one of the criteria selected. Uncontrolled epistaxis (21/27) was fulfilled most often. In comparison, only 4/71 patients admitted with epistaxis who did not undergo SPA ligation fulfilled any single criterion. All criteria were satisfied in a significantly higher number of cases in the SPA group (p < 0.001) The criteria studied proved helpful in identifying patients admitted to hospital with epistaxis who had failed conservative measures.

Recurrent or persistent carcinoma of the nasopharynx or naso-ethmoid region occurs even after combined surgery and radical external irradiation. The confined bony access and proximity of vital structures may compromise resection margins. Brachytherapy using implantable radioactive gold or iodine seeds is a useful adjunct to the skull base surgeon in eliminating residual microscopic disease. We report nine cases with recurrent or persistent disease of the nasopharynx or naso-ethmoid regions treated with brachytherapy with encouraging results.

The expiratory wheeze of an obstructing lower airway in acute severe asthma is a common presentation in the emergency department and most physicians are well versed with the basic principles of initial assessment and management.

Over the eight-year period to May 1991,256 patients were referred for post-laryngectomy voice rehabilitation. Videofluoroscopy identified 81 (32 per cent) who required pharyngeal myotomy for a spastic pharyngooesophageal segment. Forty-two of these (37 male, 5 female and average age 63 years) had their surgery performed at this unit with a complication rate of 17 per cent and an average post-operative stay of 10 days (range 4–41 days). The place of the operation for pharyngeal myotomy in post-laryngectomy voice rehabilitation is discussed.

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