Residual cholesteatoma was experimentally produced in guinea pigs by transplanting a free skin graft into the middle ear bulla. In group A, the graft was placed on the mucosa after scratching the surface with a pick, while in group B, it was placed on the bone surface following removal of the mucosa and drilling with a diamond burr. The group A procedure was conducted on the left ear and the group B procedure on the right ear in 12 guinea pigs. The animals were sacrificed at two, four and eight weeks after transplantation. In all 12 ears of group A, the graft kept its original flat shape, resembling an open type residue. In eight of 12 ears of group B, the graft grew forming a squamous pearl, while in the remaining four ears it retained a flat shape. The difference in configuration is thought to be due to the amount of granulation around the graft.

Grafting of the tympanic membrane (myringoplasty) has traditionally been performed as an in-patient procedure in the UK. We have performed day-stay myringoplasty on 21 consecutive patients (15 adults and six children) under general anaesthesia using an underlay temporalis fascia graft. In 18 cases there was complete healing of the tympanic membrane and in three cases the patients developed perforations at four weeks. This success rate is consistent with previously reported studies. All patients were discharged on the day of admission with no major complications.

We have compared the results with a group of patients having the same operation as an in-patient and have concluded that day-stay myringoplasty under general anaestheia is as safe and effective as in-patient surgery for the majority of patients.

Between April 1990 and June 1996, the extraosseous portion of endolymphatic sac has been removed from the affected ear in 77 patients suffering from Menière's disease. Removal of the extraosseous part of the endolymphatic sac without any drainage procedure did not increase the frequency or severity of the attacks of vertigo in any patient. The results of 43 patients with unilateral disease who had a follow-up period of two years are presented. Only eight of the patients had more than two recurrent attacks of vertigo lasting over two minutes within the two years after the surgery, and in three of these patients the severity of the attacks was greatly reduced. In 56 per cent of the operated ears, the hearing deteriorated at least 10 dBHL across five audiometric frequencies (250 Hz, 500 Hz. 1 kHz. 2 kHz and 3 kHz). To the author, endolymphatic sac removal appeared to provide better relief from vertigo than a simple drainage procedure with less tendency for recurrence several months or years after the initial surgery. At present, the statistical analysis of the results shows no significant difference between removal of the extraosseous portion of the endolymphatic sac and the ‘so called’ endolymphatic sac drainage procedures.

A labyrinthectomy is known to relieve vertigo successfully in the majority of patients who suffer from Menière's disease and have non-serviceable hearing in the affected ear. It is assumed that the procedure reduces disability, helps the patient to return to work and improves the quality of life. Eighteen patients who underwent a transmastoid drill-out labyrinthectomy between 1980 and 1990 were interviewed and an attempt was made to evaluate the success of the operation in accordance with the guidelines set out by the AAO-HNS 1985. In the present series it was noted that although vertigo was relieved in 89 per cent of patients after labyrinthectomy, only 50 per cent of them returned to work. In this study, the age and occupation of the patient at the time of surgery and the relief of vertigo did not accurately predict whether or not a patient returned to work.

The possible involvement of depression on cellular immunity in reactivation of varicella-zoster virus (VZV) in herpes zoster oticus was investigated. The subjects comprised 59 cases of herpes zoster oticus, 33 cases of herpes zoster sine herpete (ZSH) with facial paralysis, and 205 cases of Bell's palsy. The transformation rate of lymphocytes to phytohaemagglutinin in herpes zoster oticus tended to be lower than that in Bell's palsy. In skin tests with purified protein derivatives of tuberculin, the positivity rate in herpes zoster oticus was significantly lower than that in Bell's palsy (p<0.015). In skin tests using VZV antigen, the positivity rate in herpes zoster oticus and ZSH were significantly lower than that of Bell's palsy (p<0.001 and p<0.015, respectively). Thus, it was noted that cellular immunity, especially specific cellular immunity against VZV, was significantly depressed in herpes zoster oticus and ZSH. We consider that depression of specific cellular immunity plays an important role in triggering reactivation of VZV and onset of these diseases.

The per-operative instillation of ototopical antibiotic/steroid drops reduces the incidence of early otorrhoea after tympanostomy tube insertion. Whether this is due to the chemical properties of the antibiotic/steroid or simply the mechanical instillation of fluid is unclear. In this paired matched study of 161 subjects Gentisone HC was shown to significantly reduce the otorrhoea rate compared to normal saline (1.24 per cent compared with 9.32 per cent, p<0.005, difference 8.07 per cent, 95 per cent confidence interval for difference 3.21 per cent to 12.93 per cent). Capillary viscosimetry proved Gentisone HC to be more viscous than normal saline. The benefits are due to Gentisone HC's chemical properties, and Gentisone HC rather than normal saline instillation per-operatively is recommended when tympanostomy tubes are inserted.

This paper evaluates post-irradiation hearing changes in patients with nasopharyngeal carcinoma (NPC) from a disability orientated approach, which takes into account binaural hearing. Newly diagnosed patients with NPC were studied before radiotherapy, and at four to 12 months (mean 9.2 months) after radiotherapy, provided they remained disease-free. Each patient was examined clinically and with pure tone audiograms. Tympanometry was used to confirm middle ear effusion. Averaged hearing thresholds over 0.5,1 and 2 kHz were evaluated. If abnormal (>30 dB), the resultant hearing disability was illustrated by a modified Glasgow Plot. Twenty-three males and 10 females completed the study. Middle ear effusions resulted in 39.3 per cent (binaural in two patients) and 33.3 per cent (binaural in five patients) of patients having hearing disability pre- and post-irradiation respectively. No patient had hearing disability as a result of a sensorineural loss. It is recommended that future reporting of post-irradiation hearing changes in patients with NPC, as in middle ear surgery, be considered from a disability-orientated approach.

In this prospective study, the author studied four local ENT departments to discover how many temporal bones were being harvested. The results show that only eight per cent of routine post mortems have temporal bones removed.

Olfactory neuroblastoma is an uncommon tumour arising in the nasal cavity or paranasal sinuses. We report the management of nine cases treated with external beam radiotherapy subsequent to sureery, either attempted definitive removal or biopsy only. Recent refinements in pathologicalevaluation of these tumours are discussed. Seven cases were deemed classical olfactory neuroblastoma whilst two were classified as neuroendocrine carcinoma. The clinical features, radirap technique and variable natural history are presented. Seven of eight patients treatecall were controlled locally, with a minimumfollow-up of two years. Three patients developedcervica lymph node disease and three patients died of systemic metastatic disease. Suggestios are made as to which patients should have en-bloc resection rather than definitive radiotherapy.

An animal model has been devised to allow trainees in nasal and sinus endoscopy to develop basic instrument handling and psychomotor skills, without risk to patients.The sheep's head obtained from the abattoir was modified slightly to simulate more closely the human situation. The model permits nasendoscopy, foreign body removal, septoplasty, turbinate reduction, frontal and maxillary sinoscopy, antrostomy and an epistaxis exercise. To date the tissues have been used freshly thawed, and must be used on the day of preparation.

The Birmingham bone anchored hearing aid team is part of the Birmingham osseointegrated programme. In the first seven years of its existence it has received 309 referrals. Twenty-six per cent had suffered a congenital conductive hearing loss and 74 per cent had an acquired conductive hearing loss; the majority secondary to chronic suppurative otitis media.

This report is of 68 out of 106 adults wearing bone anchored hearing aids (BAHAs). Ninety-eight per cent showed audiological improvement with the congenital group demonstrating marginally the best freefield thresholds and speech discrimination. Questionnaire data as to the patient experience confirms the benefits especially hearing in noise, and comfort, and the vast majority were more satisfied with the bone anchored hearing aid than their previous aid.

In 1861 Prosper Menière separated patients with episodic vertigo, hearing loss and tinnitus from a group previously described as having apoplectiform cerebral congestion. He suggested the cause was disease within the semicircular canals (Menière, 1861). Over the years it becoame apparent that within this group there were a number of patients with characteristic signs and symptoms and in 1938 a pathological correlate was found in the form of endolympatic hydrops. Descriptions scuh as Menière's ‘Menière's ‘disease’, Menière's ‘syndrome’ and Menière' ‘symptom complex’ led to a confusing array of terms for this condition and monotoring of treatment results became difficult. In response to this in 1972 the American Academy of Ophthalmology and Otolaryngology and Otolaryngoly Committee on Hearing and Equillibrium published a clear definition of Menière's disease and criteria for the reporting of treatment results, it was updated in 1985 and again in 1995. We described the changes that have taken place as the definition of Menière's disease has evolved.

Percutaneous tracheotomy is a surgical procedure for inserting a tracheal cannula into the tracheal lumen without a large incision, without extensive dissection of pretracheal tissue and without exposure of the trachea. Ciaglia's report on the procedure a decade ago led to this technique gaining popularity, although its origin is much older.

Vestibular neurectomy is an effective procedure in the management of vertigo due to active labyrinthine disease. Various approaches have been developed for selectively sectioning the vestibular nerve, in order to preserve serviceable hearing and avoid facial nerve injury.

In patients who have a mastoid cavity, from previous surgery for chronic otitis media, the approach to the vestibular nerve has to be modified. Considerations taken into account are cavity infection, hearing status, and the presence of associated loud tinnitus.

Vestibular or vestibulo-cochlear nerve section has been undertaken, by the senior author, in eight patients with a mastoid cavity from previous surgery for chronic otitis media. Translabyrinthine, retrosigmoid and middle fossa approaches have all been used; strategies for selection of each specific technique are considered, and the aetiology of post-chronic suppurative otitis media (CSOM) peripheral vestibular disease discussed.

The case notes of 34 patients undergoing rehabilitative facial nerve surgery between 1978 and 1994 were retrospectively examined. Thirteen patients underwent facio-hypoglossal transposition with six achieving a facial nerve grade of IV (House-Brackmann scale) at 24 months post-surgery. Twelve patients underwent cable grafting of the facial nerve defect. Of these, 10 achieved a grade III result at 24 months. Nine patients underwent end to end anastomosis of the facial nerve, seven achieving a grade III result at 24 months after the repair. Re-routing of the facial nerve and the use of tissue glue to effect the anastomosis did not have an adverse effect on the outcome. Comparison of rerouted end to end anastomosis with non-re-routed cable grafting showed no difference. Patients presenting pre-operatively with facial weakness and those in whom nerve repair surgery was delayed for more than six months were less likely to have a good result.