Otomycosis (fungal infection of the ear) is a not uncommon clinical problem encountered in our ENT practice. It makes up to 6 per cent of all patients with symptoms of ear disease seen in the Outpatient Clinic. Of the 193 patients with a clinical diagnosis of otomycosis, 171 cases produced positive fungal isolates. In this study Aspergillus species (niger and fumigatus) have been the most common fungal pathogens. Various aetiopathological factors have been examined in detail, and the available literature reviewed. The results of the treatment by nine antifungal agents currently available in Bahrain have been analysed.

Congenital first branchial cleft fistulae, their embryology, anomalies, varied relationships to the facial nerve and surgical techniques for their excision have been well described in the literature. We report a case of a type II first cleft fistula in a three-year-old child which required a modification of the standard surgical approach to achieve safe and complete excision with identification and preservation of the facial nerve.

Cystic lesions of the thymus are rare. In a large series of over 200 mediastinal cysts only 12 cases of thymic cysts have been reported (Seltzer et al., 1968). Cervical thymic cysts are so rare that only 35 cases have been documented in the English literature. (Al-Shihabi and Jackson, 1982).

We report a case of vasculitis causing facial swelling and exophthalmos which on clinical and histological grounds is thought to be limited Churg-Strauss syndrome. An excellent response was achieved to high doses of systemic steroids and cyclophosphamide.

To the Editor.\p=m-\Reflexdry cough from vagal stimulation (auriculovagal reflex) by impacted cerumen or a foreign body in the external auditory canal can occur.1,2 Implanted hair in the bony external auditory canal causing similar symptoms is not yet reported in the literature, to our knowledge. We now report a case that was referred to us by our colleagues, after they were unable to find a cause for a middle-aged patient's cough, in spite of an extensive investigation of his problem. While examining his ears, it was remarkable to find a few implanted hairs on the skin of the posterior bony canal touching the eardrum. Also, there were a few loose hairs impacted on the eardrum itself. On further questioning, he was found to be an obsessive "self\p=n-\ear-cleaner." After removal of these hairs, his symptoms disappeared. He was advised to abstain from self-cleaning his ears, and follow-up for three months did not reveal any recurrence of his symptoms. We emphasize the fact that, in patients having unex¬ plained cough, one must also examine the ears properly.