The conventional neurosurgical management of cerebrospinal fluid (CSF) rhinorrhoea has been by intracranial access. Otorhinolaryngologists have undertaken extracranial approaches where access has been possible, and more recently an endoscopic approach has been advocated. We report 17 patients with confirmed CSF rhinorrhoea treated with endoscopic techniques between 1993 and 1996. Follow-up ranged from four to 32 months and showed an overall closure rate of 16 out of 17 patients with no complications. No patient undergoing primary endoscopic repair developed anosmia. The use of fluorescein helped localize the site of the CSF leak in four patients in whom the computed tomography (CT) scan had not identified the site of the defect.We conclude that the endoscope is a valuable tool in the evaluation and subsequent treatment of CSF rhinorrhoea. Where the skull base defect is accessible to the endoscope, we propose that an endoscopic approach should be considered as the preferred method.

The data from 140 consecutive patients who had undergone computerized tomography (CT) as part of their investigation for nasal symptoms, and who had been examined by one surgeon, were retrospectively reviewed. The history, rhinoscopic findings, endoscopic findings, changes on CT and final diagnosis were noted. Endoscopy was found to identify more disease than rhinoscopy (85% versus 74%); and a similar picture was seen when combining history with either endoscopy or rhinoscopy. Endoscopic examination was found to have a sensitivity of 84% and a specificity of 92%. In 25 (18%) patients endoscopy contributed positively towards a correct diagnosis, but in 11 (8.0%) there were false positive findings. CT findings led to a re-evaluation of the diagnosis and alteration of management of these 11 individuals who had false positive endoscopic findings. History alone led to an accurate diagnosis in 84% of patients with inflammatory nasal conditions. The role of the endoscope is best considered as 'fine tuning'; and supplementary to a detailed history.

The case notes of 185 patients who had bismuth-iodoform-paraffin paste (BIPP) impregnated ribbon gauze used for packing following ear surgery were analysed retrospectively. The incidence of hypersensitive allergic reactions to BIPP was 5.9 per cent and a five-fold increase risk of developing allergic reactions was found in those with previous exposure to BIPP. Where temporalis fascia was used to repair tympanic membrane defects, the incidence of tympanic membrane graft perforations was higher when allergic reactions to BIPP developed post-operatively, compared to non-allergic cases.

A patient is presented who had bilateral abductor vocal fold paralysis pathologically proven to be due to multiple system atrophy (MSA) in the absence of other neurological features. MSA is a degenerative neurological condition that includes olivopontocerebellar atrophy, Shy-Drager syndrome and striatonigral degeneration. The usual predominant features of MSA are cerebellar ataxia, autonomic dysfunction and Parkinsonism. Stridor is present in over one third of patients and has been reported previously as a presenting symptom in MSA: however previously reported patients have always gone on to develop other neurological symptoms. The usual investigations of bilateral abductor vocal fold paralysis caused by MSA will not reveal the pathological process and we believe that magnetic resonance imaging (MRI) of the medulla and brain stem and autonomic function tests are probably the investigations of choice. It is a worthwhile exercise attempting to identify MSA as the cause of stridor as the prognosis is good in the medium term if appropriate support is offered.

Haemangioma of the parotid gland is a well-described condition that accounts for 50 per cent of parotid tumours presenting during the first year of life. Parotid haemangiomas in adults are much rarer and until now only the cavernous variety have been reported. We report a case of a capillary haemangioma in an adult and discuss the literature.