Schneiderian-type papilloma of the middle ear is a rare finding. We present a 46-year-old Aboriginal man with a large tympanic membrane perforation and a Schneiderian-type papilloma filling the middle ear. The aim of this study is to familiarize clinicians with this uncommon disease through discussion of its clinical presentation, diagnostic considerations and management. A search of English-language peer-reviewed literature was undertaken using the key words ''Schneiderian-type papilloma,'' ''inverted papilloma,'' and ''middle ear.'' A total of 29 cases (including the present case) of Schneiderian-type papilloma involving the middle ear were reviewed. Common presenting symptoms include hearing loss, otalgia, and otorrhea. Middle ear disease is associated with higher rates of recurrence and malignant transformation than its sinonasal counterpart. Radical surgical resection is the only curative treatment. Schneiderian-type papilloma is a benign, but locally aggressive, epithelial neoplasm most commonly arising in the sinonasal tract. Whilst involvement of the middle ear is extremely rare, knowledge of this condition is important due to its propensity to recur and the high rate of malignant transformation.

Background Topical nasal decongestant sprays are used commonly in routine otolaryngology practice to reduce the symptoms of nasal airway obstruction (NAO) through vasoconstriction, thereby reducing the bulk of vasoerectile tissue and increasing nasal airflow. Such tissue is found predominantly on the lateral wall of the nose within the inferior turbinates (ITs), but recent evidence suggests that it may also be found medially within the nasal septal swell body (SSB). Objective To determine whether isolated topical decongestion of the medial nasal wall, targeting the SSB, is as effective as isolated decongestion of the lateral nasal wall, targeting the IT, in maximizing nasal patency. Methods A double-blinded, randomized controlled, crossover study was performed investigating the effect of decongestion of the lateral nasal wall or septum in isolation on nasal airflow. Isolated decongestion was performed by placing a cottonoid, soaked in oxymetazoline and attached to a silastic sheet, into the nasal cavity randomly facing either the septum or lateral nasal wall, bilaterally. Anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow (PNIF), and subjective patient-reported outcomes (Sinonasal Outcome Test (SNOT-22) and Nasal Obstruction Symptom Evaluation (NOSE) scores) were recorded at baseline and postdecongestion. Decongestion of the alternate site was then performed at a later date. Results A total of 20 healthy volunteers (30% females, mean age 26.6 ± 3.8 years) were recruited. Improvements in nasal obstruction and SNOT-22 scores were found following decongestion of the septum compared with baseline (mean difference: 0.82, t = 2.32, P = .04; mean difference: 3.30, t = 2.50, P = .04, respectively). Improvements in mean inspiratory flow, minimal cross-sectional area, volume, and PNIF were also demonstrated. Conclusion This study suggests that the SSB contains erectile tissue that responds to topical decongestant therapy in a similar manner to IT tissue. The SSB may represent a novel target in surgery for NAO.

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Background: Foreign body ingestion is a common problem in paediatric populations, with the most common culprits being coins or small toys. Fish bone ingestion is much less common in children than in adults. Fish bone impaction may lead to serious complications if untreated and, in children, often represents a diagnostic challenge. We review the presentation, investigation and management of fish bone impaction at an Australian tertiary paediatric hospital.Methods: Hospital records of all children presenting to a single, tertiary paediatric centre over a 10-year period for suspected foreign body impaction were identified and retrospectively reviewed specifically for fish bone impaction. Demographic data, presenting history, observed location, investigations performed and outcomes were assessed.Results: Forty-two children (mean age 6.2±4.0 years, 40.5% female) were identified as presenting with fish bone ingestion, accounting for 8.0% of all foreign body impaction over the 10-year period. Mean time to presentation from time of impaction was 19 hours. Seventeen children had a demonstrable fish bone in situ at time of review: 15 required removal; 1 passed spontaneously; and 1 was regurgitated. Ten fish bones were identified in the oral cavity. Plain X-ray was useful in identifying a fish bone in only 3 of 28 cases where X-ray was performed. No complications were experienced.Conclusions: Fish bones are uncommon foreign bodies ingested by children. Most fish bones were identified within the oral cavity or oropharynx, reinforcing the importance of thorough oral examination.Plain X-rays have limited sensitivity in the diagnosis of an impacted fish bone in children.

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