Ramsay Hunt syndrome is known to cause audiological signs and symptoms, including sudden, unexpected hearing loss. We carried out a retrospective review of the audiological manifestations of 186 patients with Ramsay Hunt syndrome, measuring their hearing loss patterns, hyperacusis, tinnitus, herpetic rash, facial paralysis, pain and vertigo. Statistical correlations of these parameters were equated with prognosis. Prognosis for eventual hearing recovery is, in general, excellent. Prognostic indicators of poor hearing recovery include advanced age, retrocochlear hearing loss, male gender, vertigo, and speech frequency hearing loss.

A series of 116 young adults with cancer in the head and neck who had been followed up for five years or longer were reviewed. The study aimed to assess whether malignancy in this age group was increasing, whether their prognosis was worse and if so, why. They were compared with data available on the patient population as a whole treated during the same period. This demonstrated that it is the intrinsic characteristics of the tumour, its site and extent rather than the age of the individual which determines prognosis though the ratio of men to women was less in the young adults in several sites possibly due to a diminished impact of recognized aetiological factors.

Canal wall-down technique tympanoplasty was indicated in about 41 per cent of our cases with chronic suppurative otitis media. In this series done during the last four years, of 576 tympanoplasties, 240 cases needed type III tympanoplasty. In 145 cases, myringostapediopexy was carried out using temporalis fascia grafting over the head of the stapes. Tympano-cartilago-stapediopexy was performed in the other 95 cases by using tragal cartilage and perichondrium over the stapes. A comparison between the results of both methods of grafting is discussed. Improvement in hearing was achieved after tympano-cartilago-stapediopexy. This method proved to be suitable for those cases which need open technique tympanoplasty.

Idiopathic glossopharyngeal neuralgia is an uncommon disorder which often fails to respond to medical treatment. Surgical treatment most commonly consists of intracranial section of the glossopharyngeal nerve and upper vagal rootlets. We present three cases treated by the much simpler pharyngeal approach and argue that in appropriately selected patients this approach should receive more serious consideration.

The results of a first series of fifty stapedectomies, using newly adopted ‘Fisch stapedotomy technique’ are presented and contrasted with ‘world results’ and results of leading otologists.

The essential points in the evolution of stapes surgery are outlined.

In the light of the small number of deaf otosclerotics the philosophy of who should be performing stapes surgery and who should be trained to perform it, is discussed.

The title ‘Collective Stapedectomy’ denotes personal system of collecting patients from the waiting list in batches and operating on each stapedectomy batch in consecutive fashion.

An increasing number of patients with an acoustic neuroma present with useful hearing in the tumour ear. Surgical removal of these tumours via the posterior fossa route may enable preservation of the cochlear nerve and otic capsule without increasing the morbidity to the facial nerve. The results of treating 51 cases of acoustic neuroma via the posterior fossa is presented. Forty four tumours measured less than 20 mm in diameter in the cerebellopontine angle and surgery was undertaken with hearing preservation as a principle objective. In 26 cases, the cochlear nerve was preserved anatomically and post-operative hearing at levels better than mean pure tone threshold of 50 dB or 50 per cent speech discrimination was recorded in 14 patients. The preservation of hearing represents a worthwhile surgical goal in selected patients with an acoustic neuroma without increasing the operative morbidity.

Tissue samples from fourteen consecutive (8 male: 6 female) acoustic neuromas were assayed for hormone receptors using either a monoclonal antibody (MA), dextran coated charcoal (DCC) or isoelectric focusing (IEF) technique.

In this series there were no unequivocally positive results, a finding at variance with previously published results.

The late results of one stage operation for middle ear tymanosclerosis in 73 patients during the period January 1965 to December 1980 are presented. Mean observation time was 11.2 years (range 3–20.2 years), with a follow-up rate 86 per cent. Among 64 patients with stapes fixation, 59 had removal of tympanosclerotic masses and stapes mobilization, and five cases underwent stapedectomy. The series was divided into six groups and the results analyzed. The best and most stable results occurred in the group with stapes mobilization and an intact ossicular chain followed by the group with stapes mobilization and Type II tympanoplasty with incus interposition. The poorest late results were obtained in ears with lacking stapes crura and stapes mobilization, and in ears subjected to stapedectomy. No case of post-operative sensorineural hearing loss occurred. We recommend that care is taken to preserve an intact ossicular chain at stapes mobilization performed at the same stage as myringoplasty. Also in ears with a defective ossicular chain but intact stapes with tympanosclerotic fixation we recommend stapes mobilization in one stage. In ears with fixation of the stapes footplate and defective crura, we recommend stapedectomy or stapedotomy in two stages.

A retrospective study to assess the clinical usefulness of non-surgical management of epistaxis was performed on 340 patients requiring hospitalisation at the ENT Department of La Paz Hospital (Madrid). The previous history, type of management, hospitalisation time, and volume of transfusion were considered. Nasal packing was employed in 94.1 per cent of the patients. Most patients (82.9 per cent) were hospitalised less than seven days, and 84.1 per cent of the patients required no transfusion. There was one death.

This study supports the clinical usefulness of conservative management in the treatment of patients with epistaxis.

Twenty-five cases suffering from rhinoscleroma were divided into two groups The first group consisted of 15 patients treated with rifampicin systemically The other group consisted of 10 patients treatcd locally with rifampicin in the form of ointment. Electron microscopic study of the pathological changes in the lesions showed that rifampicin is highly effective both systemically and locally in the treatment of rhinoscleroma.

Otitis media with effusion (OME) is a common condition among children and is characterized by nonpurulent fluid in the middle ear and fluctuating conductive hearing loss. Most children will spontaneously regain normal air-filled middle ears, but a certain number will have persistent problems. In our department we will treat annually about 500 children on an outpatient basis, with the insertion of ventilating tubes in the eardrum. The reason for this study was to evaluate the effect of erythromycin, instead of inserting a ventilation tube, in children with bilateral OME of longer duration than three months (double blind/placebo). The study comprises 147 children, 1–15 years of age, 83 boys and 64 girls, all with OME for more than three months. All the patients were candidates for tube insertion. In the group treated with erythromycin, 12 patients out of 69 had bilaterally air-filled middle ears after one month, as compared to 19 out of 72 in the group treated with the placebo. No difference was noted due to sex or age. The results support our indication and timing for ventilation tube insertion.

Despite the complex embryological development of the nose and surrounding structures, significant developmental nasal anomalies are rare. We therefore present our experience in the management of such anomalies (excluding choanal atresia) over the past 10 years.

Fifty cases were surgically treated; two nasopharyngeal cysts, four hairy polyps, two meningoencephalo coeles, seven gliomata, 20 dermoids, two capillary haemangiomata, four fibromas, one fibromyxyoma, one mucocoele, one granuloma, one lipoma, two nasal aplasias, two nasal clefts and one nasal web. All cases presented with nasal obstruction and/or as a nasal mass. Computerized tomography and magnetic reson ance imaging aided diagnosis determining the extent of intracranial involvement. Various surgical tech niques were used ranging from simple excision to the lateral rhinotomy and Goodman's external rhinoplasty approach. Only five patients (10 per cent) suffered complications; two CSF leaks and three recurrences, all treated successfully.

We report six cases of partial lower motor neurone facial palsy occurring between four and ten days after uncomplicated stapedectomy. The aetiology is unclear but recovery was rapid and complete in all patients.

The traditional ways of treating earache among the Lappish people have been charted. Generally speaking, the Lapps have treated earache by applying a compress to the ear, dropping various ear-drops into the external auditory canal, breathing into the ear, massaging the ear, and inserting impregnated wool into the ear canal. The Lappish treatment principles for earache are discussed in relation to modern knowledge of pain relief.

This essay attempts to address the perennial question ‘Why Paranasal Sinuses?’. In doing so it highlights the flaws in many much-favoured but ill-founded theories concerning the role of these sinuses in humans. It is concluded that the question can only be fully answered through a greater understanding of differential growth changes within the craniofacial massif.

One-and-a-half per cent of adults have active chronic otitis media and its management to prevent complications is a considerable workload. The risks of developing these complications is relatively unknown but because of its mortality, intracranial abscess is the most relevant.

A 10-year review of all otogenic intracranial abscesses in Scotland was carried out. A 15 per cent allowance was made for missing records. The annual risk in an adult with active chronic otitis media of developing an abscess is about one in 10,000 but its development is three times more likely in males. This risk might appear low but the lifetime expectancy of an individual aged 30 years with active chronic otitis media developing an abscess is one in 200. However, as yet, there is no evidence that surgery reduces this risk. Unfortunately, because of the duration of follow-up needed and the size of the sample required, scientific evidence would be difficult to obtain. However, 5 per cent of abscesses currently occur in the immediate post-operative period following mastoid surgery.

The use of diathermy in achieving haemostasis at tonsillectomy was assessed by means of a postal questionnaire sent to consultant otolaryngologists practising in the U.K. A response of 81 per cent was obtained. Forty-four per cent presently use diathermy. Few considered the age of the patient or a history of a quinsy a contraindication to its use. The diathermy experience of users and non-users with regard to speed, postoperative pain and haemorrhage differs markedly. This dichotomy of opinion is confirmed by a review of the literature. Clearly there is a need for further studies to clarify the role of diathermy in tonsillectomy.

Labyrinthine destruction by direct cholesteatoma invasion has always been considered a serious threat to the inner ear function.

A number of reports in the literature have cited both patients who had preservation of hearing despite widespread erosion of the labyrinth by cholesteatoma and patients who had retained auditory function despite surgical removal of the matrix from the labyrinth. In most cases the vestibular portion of the inner ear was invaded but cases of cochlear involvement have been described as well.

Twelve cases with pre-operative auditory function preservation despite extensive labyrinthine destruction treated at our Institution are reported. Seven cases retained cochlear function post-operatively.

Possible explanations of this occurrence and implications of related with hearing preservation in the presence of widespread inner ear destruction by chronic inflammatory disease are discussed.

The Eustachian tube acts as pressure equalizing tube between the nasopharynx and the middle ear. It also functions as a conduit for removal of secretions from the middle ear and mastoid air cell system into the post nasal space. Eustachian tube function may be assessed objectively using tympanometric measurements. (Brooks, 1968, Lutman, 1987).

The post-operative use of nasogastric Ryles tubes is associated with reduced peak middle ear pressure (mmH2O) and reduced peak compliance volumes (ml) as assessed by tympanometry. In addition changes in the appearance of the tympanic membrane may occur with the protracted use of Ryles tubes. This phenomenon is a transient one.

Nasogastric tube-induced Eustachian tube dysfunction is a previously unreported entity.

One hundred and seven consecutive patients with acute and chronic epistaxis were examined to identify the site and nature of the source. Aetiological factors in the history, nasal anatomy or pathology were noted, along with the blood pressure and laboratory results.

In most presentations an anterior bleeding point was isolated. Cautery usually sufficed in both anterior and posterior sources. No source was hidden behind a septal spur or deflection. Hypertension was associated with bleeding from the middle meatus, but not with the severity of bleeding. Patients on antihypertensive medication were more likely to be admitted.

Point sources of bleeding were from prominent vessels or haemorrhagic nodules; the latter are not well recognized and are easily overlooked.

Routine blood tests did not reveal unsuspected abnormalities or change management; neither did sinus X-rays.

Initial examination of the nose in the acute phase by experienced personnel is suggested, to reduce admissions and avoid nasal packing.