Since 1946 authoritative reports have identified smoking as a cause of cancer of the lung and a probable cause of cancer of the larynx. Crown Prince Frederick (later Emperor Frederick III of Prussia and the German Kaiser) was a pipe smoker for at least 30 years before he died of cancer of the larynx in 1888 at the age of 57 years. The evidence is so overwhelming that this author proposes that the Emperor's laryngeal cancer was induced by tobacco.

Eighty-nine cases of attic type cholesteatoma were operated on during a three and a half-year period. Of these, eight cases were characterized by bony tissue proliferation at the aditus ad antrum or mastoid antrum. Sex, age, and hearing levels were not significant in these cases. Bony fixation of the incus and the malleus was seen in six cases. Bony tissue blocked further expansion of attic cholesteatoma at the aditus in four cases, narrowed the epithelial tract to the antrum in two cases, and completely separated the cholesteatoma into two cholesteatomas in two cases. Infectious stimuli, at an early stage of the disease, might stimulate such osteoplastic activity at the aditus. Axial CT scans give useful information regarding structure before surgery.

Quality of life assessment as part of clinical practice in head and neck oncology began over 40 years ago. Early studies were narrative and cross-sectional; these were followed, at first, by simple quantitative measures of various parameters and later by longitudinal studies of greatercomplexity. More recently quality of life has been employed in a randomized clinical trial of head and neck cancer.

Quality of life has evolved to become a standard means of assessing clinical outcomes, and an accepted end point measurement in clinical trials, to be considered alongside survivorship and side effects/complications.

Managing patients with failed canal wall down mastoidectomy, requires a meticulous approach to control the disease and restore hearing. The present article reviews the causes of failure of the primary procedure and pitfalls encountered in 105 patients referred to our centre for revision canal wall down mastoidectomy. At post-revision surgery there were no cases with residual or recurrent cholesteatoma. The failures in our revision procedure were due to tympanic membrane perforation which occurred in five percent (n = 4) and intermittent otorrhoea in two percent (n = 2). A dry cavity with adequate middle ear space allowed for optimum audiological function even in revision canal wall down procedures.

Frederick III (Crown Prince of Prussia, and Emperor of Germany) died of cancer of the larynx in 1888. In Drame Imperial (1888) journalist Jean de Bonnefon asserted that the disease was not cancer but syphilis which the Crown Prince acquired in 1869 in Suez. What de Bonnefon wrote about the prince does not coincide with the prince's itinerary published in the London Times. This discrepancy is examined and the reason for de Bonefon's claim is considered. The report that Crown Prince Frederick of Prussia caught syphilis in Suez is a canard.

The Birmingham Mummy is of a warrior, 25–35 years of age, from the Graeco-Roman period. He was struck from the front by an arrow, which penetrated the soft tissues of the neck to some depth and lodged in the right infratemporal fossa. It is suggested that the wound became infected and that muscle spasm induced the torticollis which was not fully corrected on mummification.

The objective of this paper was to determine the effectiveness of combined steroid-antimicrobial therapy for otitis media with effusion (OME) of sufficient duration to justify tympanostomy tube insertion.

A consecutive sample of 122 children with bilateral OME of at least three months duration, or unilateral OME of at least six months duration, despite treatment with one or more beta-lactamase stable antibiotics was studied. The treatment group received prednisolone plus a beta-lactamase stable antibiotic for 10 days, with responders receiving an additional six weeks of chemoprophylaxis. The control group received no medication. The child's caregiver decided which group the child should be in.

Resolution of effusion in all affected ears occurred in 32 per cent of steroid-treated children and in 2 per cent of controls (p<0.001) at three to four weeks post-therapy. Relapse of effusion occurred in over 40 per cent of initial responders within six months, reducing the final resolution rate to 25 per cent (95 per cent CI: 15–36 per cent).

It was concluded that treatment with oral steroids should be considered in selected children with chronic OME prior to surgical intervention. One in every four children whose caregiver consents to this therapy may avoid or postpone surgery for at least six months.

The subjective symptom of hyperacusis is described. The terms ‘hyperacusis’ and ‘phonophobia’ are considered to be synonymous as there is no recognized distinction between these two descriptions. Peripheral auditory pathologies with associated hearing sensitivity are reviewed and the likely mechanisms underlying the hyperacusis are listed. The neurological conditions, which have been reported to occur with hyperacusis, are reviewed. A separate aetiology of central hyperacusis is therefore proposed, with a symptom profile distinct from the peripheral hyperacusis

A common factor to neurological conditions with hyperacusis, is disturbance of 5-HT (5-hydroxytryptamine) or serotonin function. The research literature on the role of 5-HT in sensory modulation (specifically auditory startle) in animals is presented. It is proposed that 5-HT dysfunction is a probable cause of increased auditory sensitivity manifested as central hyperacusis or phonophobia

A questionnaire was sent to all Full Members of the British Association of Otolaryngologists to ascertain whether and what type of eye protection surgeons and theatre nurses wear during mastoid surgery. Despite Department of Health recommendations only 58 per cent of surgeons and 19 percent of theatre nurses routinely wear any form of eye protection.

The sensory supply of the middle and external ear is complicated by multiple neural communications. The anatomy of these communications and their clinical significance will be described in this paper.

A retrospective study of 74 Shah Permavent tube insertions is presented. These were inserted into 74 ears of 55 patients during the period between 1985 and 1988. At the time of review, 35 tubes had extruded spontaneously, 11 tubes had been removed for recurrent infections, 10 tubes had been removed electively and 10 tubes were still in situ. On examination of the ears approximately 12 months after the tubes had extruded, the overall rate of tympanic membrane perforation was 18.2 per cent. In ears in which the Permavent tube extruded spontaneously the perforation rate was 22.2 per cent. In ears in which the tube was removed because of infection the perforation rate was 20.0 per cent. However in ears in which the tube was removed electively the perforation rate was zero. This finding has implications in the use and management of long-term ventilation tubes.

The resurgence of tuberculosis world-wide and its association with HIV infection means a greater likelihood of otolaryngologists encountering the disease in one form or another. In this review the features of primary and secondary tuberculosis in various head and neck sites are described, and recent advances in diagnosis are discussed. For the otolaryngologists other important aspects such as infections with atypical mycobacteria, the differential diagnosis of cervical lymphadenopathy in HIV-infected patients, recently recognized problems in drug treatment, and the role of surgery in head and neck tuberculosis are also discussed.

Rupture of the tympanic membrane (TM) during ear irrigation is a rare but unhappy event. In this study the maximum overpressures obtained in the deep part of the external auditory meatus (EAM) during ear irrigation were measured postmortem in 20 cadavers. The highest pressures were obtained in normal- or wide-dimension EAMs when a metal syringe was used. With this device the median maximum overpressure was 240 mmHg (range 200–300 mmHg). Experiments with simulation of an obturating wax plug did not increase the maximum overpressure. Compared with the lowest overpressures which can rupture TMs the pressures measured in this study were insufficient to rupture normal TMs but sufficient to rupture atrophic TMs with the lowest tensile strength. This finding may have medicolegal implications.

After a mean follow-up period of 7.3 years, a recurrence was found in 43 (12.3 percent) out of 349 consecutive patients undergoing surgical treatment for acquired cholesteatoma. The great majority of residual cholesteatomas detected in the ‘second-look’ operations arose from the oval window area.Chronic otorrhoea and a reperforation were the most common signs of late recurrences. In eight ears a recurrent cholesteatoma developed from a retraction pocket. The recurrence rate was higher in children than in adults. The type of surgical technique had no significant effect on recurrence rate. Recurrences were more frequent in pre-operatively discharging ears than in dry ears. Some suggestions have been made to improve the results of surgery for cholesteatoma.