Tympanic membrane retraction pocket is a clinical entity which results from a disease of the whole middle ear cleft. Numerous causes are involved in the genesis of the retraction pocket; among which are the presence of an inflammatory process of the upper air ways mucosa, middle ear cleft negative pressure, tympanic membrane lamina propria atrophy and stratified squamous epithelium dysfunction. All these factors directly or successively are increased by the concomitant effect of local morphological factors which predispose to the genesis of the retraction pocket. The management of tympanic membrane retraction pocket may be divided into two main methods. The preventive management consists of routine examination under the operating microscope and suction, if necessary, with the endoscope, as well as medico-surgical intervention intended to provide the appropriate treatment of the whole middle ear cleft mucosa inflammation. The curative management varies according to the developmental character of the pathological process. It is conservative at level I. The stabilised retraction pocket of level II requires the insertion of an aerating tube and the excision of the atelectatic part of the drum. The destabilised retraction pocket corresponding to level III, needs replacement of the diseased membrane such as a total allograft myringoplasty, associated with a restoration of the volume of the mastoid air cells system.

Frontobasal dura repair is necessary to prevent endocranial inflammations. However, identification and treatment of frontobasal dural lesions is still a challenge inregard to aetiology, location and size. The endonasal approach for duraplasty was recommended recently to provide a safe and effective repair of anterior skull base defects. The authors review their experiences with endonasal duraplasty. Diagnostic aspects and surgical techniques of proven value in endonasal repair of dural lesions are presented. From July 1980 to July 1996, 95 duraplasties have been performed in 92 patients via an endonasal approach at the ENT-Department, Fulda. A successful duraplasty was accomplished in 89 patients (97%) in the first attempt. In 2 patients, endonasal duraplasty had to be repeated to achieve a safe closure. In one case ofcomplex fractures of the sphenoid sinus and lateral skull base after a severe accident, the duraplasty of the sphenoid sinus was unsuccessful and an endonasal revision was indicated, but the patient died of cardiovascular shock. The Follow up period was from I to 16 years. Endonasal micro-endoscopic surgery offers the opportunity to repair frontobasal dural lesions in a safe and effective manner. Due to its low morbidity, high success rate and good long-term result, endonasal duraplasty is recommended as a main treatment modality in frontobasal dural lesions.

Two hundred fifty eight out of 403 adult patients with a clinical diagnosis of allergic rhinitis agreed to enter the study where clinical and allergological examination were carried out. Two hundred eleven were Saudis and 47 were non-Saudis living in Riyadh for the past 3 to 5 years who never had allergic symptoms while at theirrespective countries. The aims of this work were to study the prevalence of allergic rhinitis among patients attending ear, nose and throat clinic, to identify the common allergens found,the patients life style, nationality and periodicity of the attacks in relation to aerobiological study carried out in the kingdom A comprehensive clinical history using a questionnaire were taken from all patients. All patients were skin tested with a standard set of 25 allergens selected according to local data from aerobiological studies and dust sample analysis in Saudi Arabia. The standard skin-prick test was used. Forty eight patients with no rhinological disease were skin tested as acontrol group. Perennial symptoms were evident in 175 (68%) of the Saudi nationals while in expatriate only 12 cases (25.5%) showed perennial pattern and the rest were seasonal. Skin prick test (SPT) was positive in 176 (68.2%) to one or more of the skin test allergens. The common allergens were house dust mite, cat fur, cockroach,pollens i.e. Bermuda grass and chenopodia, acacia & rhizopus. The study showed that allergic rhinitis is common among Saudis and non-Saudis living in Riyadh. There is a definitive pattern of sensitivities influenced by imported flora. Cat sensitivity showed high prevalence due to increased presence of wild cat in the environment. Other environmental stimuli including temperature changes, odours, air conditioning, emotional upset and carpeting trigger the symptoms.

Twenty-four patients with Meniere’s disease were studied for the possibility of autoimmune aetiology. Ten normal adults of matching age and gender distributionserved as controls. Both groups were subjected to a battery of laboratory tests performed to evaluate the immunologic status namely ESR, C-reactive proteins (CRP), serum immunoglobulin levels, serum complement levels and serum autoantibody levels (Rheumatoid factor, anti DNA antibody and antinuclear antibody). Also a clinical search for associated autoimmune abnormalities in both groups was performed. There was a significant increase in ESR, CRP, IgG and antinuclear antibody (ANA) levels in the study group compared to the control group. Associated autoimmune abnormality was present in two cases (8.3 %) of the Meniere’s disease group and none of the control group. Steroid treatment for selected cases of the Meniere’s disease group produced 40% improvement. These data support the opinion of an autoimmune pathogenesis of some cases of Meniere’s disease.

This preliminary study was done at Al Hada Hospital Taif, Saudi Arabia, It was planned to assess the role of induction chemotherapy and radical radiotherapy in the treatment of locally advanced untreated squamous cell carcinoma of the head and neck. Eighteen patients were included in this study. Initially all patients received 2courses of chemotherapy using Cisplatinum and 5Fluorouracil infusions. Those with a response >50% were given, another one or two courses before radical irradiation.However, those with a response <50% were commenced on radical external irradiation. The overall response rate after 2 cycles of chemotherapy was 77.7%, all responded partially to treatment. However, a complete response rate of 28.5% was elicited after 3-4 cycles of treatment. Using this protocol larynx conservation was possible in the 3 cases included in this study. Treatment was well tolerated in the majority of cases. Furthermore, no treatment related mortalities were reported in this study. The disease free survival results at a specific time in the study were 66.7%, 63.6% and 33.3% at 1, 2 and 3 years respectivelyHowever when it was correlated with the study group as a whole the corresponding figures were as follows 66.7%,38%, & 11% respectively.

Tympanoplasty is one of the commonest operations done among ENT Surgical procedures nowadays. A total of 1188 Type-I Tympanoplasty and Myringoplasty were done at TheENT Centre, King Fahad Hospital, Jeddah, during tiie period, January 1990 to December 1994 by various surgeons starting from resident to consultant. A retrospective analysis of 950 cases, which were followed up for more than 3 months was done. The male to female ratio was 46:54 and the mean age being 23.5 years. Five Hundred three cases (53%) had subtotal perforations, 333 (35%) with large central perforations and 114 (12%) had small central perforations. All the ears were dry for at least one month preoperatively. The over all success rate was 741 cases (78%). The success rate of combined posterior-anterior flap technique was higher than the posterior flap alone. The average hearing gain was 20dB. The outcome of tympanoplasty is analysed in relation to the techniques, middle ear pathology, and reasons of failure.

Congenital cholesteatoma of the middle ear and mastoid is an otologic challenge receiving increasing attention. Its site of origin and pathogenesis are still a matter of controversy. However, its power of eroding bone makes it a potentially dangerous condition that needs surgical intervention. We present two cases of congenital cholesteatoma which were involving the middle ear in one and localized in the mastoid in the other. Our pitfalls in the diagnosis were discussed after a literature review on the pathogenesis, diagnosis and treatment.