Benign paroxysmal positional vertigo (BPPV) is a common condition which is usually self-limiting. Surgical treatment is rarely required and for many years the mainstay of such treatment has been singular neurectomy (posterior ampullary nerve section). A new operation has recently been described for the treatment of BPPV involving occlusion of the posterior semicircular canal. We have performed this operation on five patients with intractable BPPV and report our results with follow up of between 12 and 36 months from operation. The excellent results of posterior semicircular canal occlusion which have been previously reported in the literature are confirmed by our experience. In our opinion the operation is a safe and effective alternative to singular neurectomy.

A case of meningitis secondary to acute suppurative otitis media in a previously healthy child is reported. The only organism isolated from blood after aerobic and prolonged anaerobic culture was identified as Fusobacterium necrophorum. Complete recovery followed treatment with surgery and prolonged antibiotic therapy. The role of anaerobes in the development of meningitis, the isolation and identification of Fusobacterium necrophorum, the clinical presentations of F. necrophorum infection and the choice of antibiotics in the treatment of these infections are discussed.

The fate of capsular fragments left attached to vital structures at the time of otherwise total tumour removal was studied in 14 of 21 such patients who underwent acoustic neuroma surgery. Imaging using magnetic resonance Gd-DTPA at post-operative intervals of 6 months-12 years (mean 70 months) showed evidence of persistent tumour in half the patients. None of the patients had developed new symptoms and computed tomography had failed to demonstrate tumour recurrence. Persistence of the tumour was more likely if the residual fragments were not cauterized at the time of operation. Four of the seven persisting tumour rests showed evidence of gradual enlargement. The implications for patient management, particularly if an attempt is made to preserve hearing, are discussed.

Orbital involvement by plasma cell tumours is rare. Orbital tumours do not generally present as an acute orbital inflammatory disease in adults, though tumours such as rhabdomyosarcoma may cause clinical signs similar to an acute orbital cellulitis in children. We describe a patient with bacterial orbital cellulitis and sinusitis who was found to have an extramedullary plasmacytoma of the maxillary antrum and orbit and coexisting testicular seminoma.

Perforation of the tympanic membrane is a frequent complication of surgery for exostoses of the external auditory canal. We report an unusual histopathological finding in a temporal bone containing external canal exostoses which suggests that some of these perforations may be unavoidable.