The otolaryngologist is frequently consulted for paranasal sinus disease which has been identified as an incidental finding on computed tomography (CT) in children. The significance of such a finding is difficult to interpret without prior knowledge of the actual incidence of chronic sinus mucosal hypertrophy in the general pediatric population. In this study of pediatric CT scans from busy otolaryngology and ophthalmology clinics, the radiographic incidence of sinus disease in the general pediatric population is estimated. One hundred forty-two CT scans of the orbits and temporal bones obtained over an 18-month period were reviewed. Fifty-eight (41%) scans showed some mucosal thickening or opacification in at least one sinus. When patients were stratified by age, or by the presence or absence of chronic otitis media or respiratory tract disease, exclusive of clinical sinusitis, there was no statistical difference between groups. The authors conclude that the asymptomatic child with an incidental paranasal sinus finding on CT scan need not be worked up further unless clinical symptoms and signs are elicited.

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First branchial cleft cysts develop as a result of incomplete fusion of the cleft between the first and second branchial arches and give rise to two distinct anomalies, termed type I and type II anomalies. Type I anomalies are purely ectodermal while type II anomalies exhibit ectodermal and mesodermal elements. The type II anomaly incorporates some portion of the first and second arch as well as the cleft. Type I lesions are extremely rare. They appear histologically as cysts lined by squamous epithelium. Clinically, they present as a cystic mass or fistula posterior to the pinna and concha. The cyst is usually superior to the main trunk of the facial nerve and ends in a cul-de-sac on or near a bony plate at the level of the mesotympanum. Type II lesions are more numerous and represent a duplication of both membranous and cartilaginous portions of the external auditory canal. They contain skin as well as adnexal structures and cartilage and may be associated with the parotid gland. Most frequently they are associated with fistulae in the concha or external auditory canal as well as fistulous openings in the neck.

Chronic rhinocerebral mucormycosis, as distinct from the acute fulminating form, has been previously unreported in the otolaryngology literature. We have observed two cases of chronic rhinocerebral mucormycosis with osteomyelitis and bony sequestration at 8 months and 2 years after apparent control of initial infection. In addition to the accepted management of early diagnosis, surgical debridement, an appropriate medical therapy, patients who have been successfully treated for acute and iulminating mucormycosis need long-term, close follow-up with further debridement should any chronic infection become evident.

The epidemic of acquired immunodeficiency syndrome (AIDS) has made an enormous impact in the practice of medicine within the past decade. Of the many associated problems, the increasing frequency of human immunodeficiency virus (HIV)-related malignancies, particularly lymphoma, has been both a fascinating area of study and a most difficult clinical condition to manage. This study investigates lymphoma of the head and neck with clinical studies, as well as immunohistochemical assessments from individual patients. Lymphomas of the head and neck, as they present to the otolaryngologist, can present difficult and challenging diagnostic and therapeutic dilemmas. It is well-known that a significant number of acquired immunodeficiency patients present initially with symptoms related to the otolaryngology field; it was also found that a certain number of lymphomas in the head and neck in HIV+ patients are the initial presentation. In addition, the associated disorders, such as related infections and synchronous additional neoplasms, are described. Also presented are recommendations for diagnosis and work-up of these conditions, based on the experience. In addition, the study of lymphoma as a neoplasm from the molecular biology viewpoint and its course in the immunodeficient state have been important areas of study in an effort to dissect the progression to oncogenesis. The rapidly expanding literature base in this area is discussed.