Mucormycosis is an acute fungal disease with high mortality exhibiting craniofacial, pulmonary, cutaneous, gastrointestinal and disseminated forms. Cerebro-rhino-orbital (CRO) mucormycosis is the type that most frequently involves the structures of the head and neck. While usually non-pathogenic, these saprophytic organisms can be particularly lethal in chronically debilitated patients. Between the years 1957 and 1982, 18 cases of CRO mucormycosis were seen at the Medical College of Virginia Hospital and the McGuire VA Medical Center. Four illustrative cases of CRO mucormycosis are presented to emphasize: the importance of clinical awareness of the disease, the necessity of tissue biopsy for diagnosis, the need of appropriate management of any underlying disorder, administration of amphotericin-B, and the performance of adequate surgery.

A report of a case of a solitary benign neurilemmoma of the auricle is presented. It is believed to be the first such documented case. Its nature, histology, and differential diagnosis is reviewed. It is suggested that "neurogenic tumors" be added on to the current classification of auricular masses.

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A congenital pit or sinus involving the ascending limb of the helix of the ear ( fig. 1 a) or the preauricular region is of little importance unless it gives rise to an offensive discharge or forms a retention cyst ( fig. 1 b). When infected, such a lesion is of considerable clinical significance, since drainage, extension, scarring and disfigurement are the common sequelae. Infection also may result in a secondary preauricular lesion, which so dominates the clinical picture that the underlying fistula itself may be overlooked entirely.Differences in nomenclature and in methods of treatment and contradictory theories advanced to explain the origin of such pits and sinuses lend confusion to a study of the literature on this subject. These embryonic structures are known by a variety of names, such as "sinus preauricularis congenita," "branchial fistula in the external ear," "fistula auris congenita," "helical fistula" and "preauricular fistula." Although these sinuses, or fistulas, are unquestionably of congenital origin, there is no certainty as to their mode of development. Many observers have assumed that they arise from the first branchial cleft ; however, Ballantyne * came to the conclusion that there are at least two difficulties which prevent the acceptance of this view : first, the freedom of the middle ear from participation in the deformity and, second, the position of the fistulas. Stammers,2 in his report of 2 cases with a review of the literature, concluded that these fistulas are not remnants of the first branchial cleft but result from an aberrant coalescence of the six tubercles which are destined to form the pinna. Ladd and Gross3 expressed the opinion that the ear is formed from six tubercles which

A case presentation of a patient receiving 8 of neomycin intramuscularly in preparation for surgery is presented. Acute renal failure and total deafness followed this injection and the temporal bones were removed on the seventeenth day postinjection. Histological findings showed inner and outer hair cell degeneration and a normal spiral ganglion count. There were some changes in the stria vascularis which were noted in the basal turn.The ototoxicity of neomycin is well known, but new case reports continue with oral ~s e , l -~ irrigations of the pleural cavitv,5 mediastinume and infected wounds.' Renal failure and deafness with intramusculars and mediastinal irrigationss have been reported within the last year.Ototoxicity of neomycin, though well known, has not been explained. Renal lesions seen in cases of ototoxicity with ncomycin suqest a common mthological process fnr the kidney and the inner ear. Stunp.9 in a study of guinea pigs, states "all antibiotics belongine to the group of aminodycosides including streptomycin and dihydrostreptomycin, as well as kanamvcin and neomycin are concentrated and retained in the inner ear fluids. Their concentration both in the inner ear and the kidney, exceeds that of all other organs, even of the blood level manv timw over. The higher the toxicity of the substances, the more intense is their accumiilation in the inner ear fluid. Evidently, there exists a relation between the concentration and the ototovicitv of the different aminoglycoside antibiotics." "In comparison, -_--other antibiotics like penicillin attain only the lowcst level of the inner ear, w h i l e tetracvcline and polymyxin (Colistin@) will not penetrate in the inner ear at all, thus lacking the ototoxic effect." Nord ct al.1° reported a study of cquimolar concentrations in mice and reported the relative toxicity of four aminoglycosides. The relative toxicity in decreasina order was neomycin, gentamycin. kanamycin and dihydrostreptomycin.