A bolt from the blew: rhinolith in the nose for more than 80 years.

Rhinoliths are calcareous concretions that are formed by the deposition of salts on an intranasal foreign body over a number of years. We describe a rare case of rhinolithiasis, whereby a small foreign body has been lodged in a man's nasal cavity for over 80 years. He presented to the ear, nose and throat clinic with a sore throat and an incidental finding of a rhinolith was made which was confirmed by x-ray. This was managed conservatively.

New approach to the endoscopic repair of a CSF leak originating from the lateral recess of the sphenoid sinus.

Difficult access can make identification of a cerebrospinal fluid leak from the lateral wall of the sphenoid sinus very difficult, especially in a well-pneumatized sinus. Access to the sphenoid sinus has become easier with the advancement of minimally invasive endoscopic technology. In this article we describe our approach to a cerebrospinal fluid leak originating from this location, which has not been described previously in the literature.

The use of silastic nasal splints in the treatment of chronic epistaxis and nasal septal ulceration.

Some cases of epistaxis are chronic and resistant to treatment. We describe a novel method of treating persistent epistaxis with Silastic splints. This procedure is simple to perform and reverse, and it is much better tolerated than is total obstruction of the nostrils (Young's procedure). In addition, the presence of the splints reduces the likelihood of digital trauma, which can prevent healing. We describe the case of a 43-year-old man with a 5-year history of persistent epistaxis who was successfully treated with this procedure.

The posterior attic: An observational study of aboriginal Australians with chronic otitis media (COM) and a theory relating to the low incidence of cholesteatomatous otitis media versus the high rate of mucosal otitis media.

OBJECTIVE: The incidence of COM without cholesteatoma in Australian aboriginals is quoted as being between 25 and 47%. The incidence of cholesteatomatous OM is very low in comparison (between 1 and 3%). A comprehensive literature search found no studies offering an explanation for the large discrepancy between these two types of OM. We offer a theory to account for the disproportionate rates of the two types of OM together with an observational study on aboriginals with COM to substantiate our argument. METHOD/RESULTS: The crux of our hypothesis centres on the anatomy of the posterior attic. We found that in a study of 40 aboriginal patients undergoing tympanoplasty with audiometric evidence of an intact ossicular chain that, after posterior tympanomeatal flap elevation, no part of the incudostapedial assembly was visible in 95% of cases denoting its location behind the posterior attic wall. CONCLUSION: We hypothesise that in aboriginal ears the resulting 'crowding' of the posterior attic by the incudostapedial assembly results in narrowing of the epitympanic space which compromises atticoantral drainage, thus leading to mucosal COM, however supporting the posterior-superior segment of the tympanic membrane, impeding the formation of a retraction pocket, and cholesteatoma formation migrating into the mastoid antrum.