When the multi-channel cochlear implant electrode is inserted into the scala tympani through the round window the operation is best performed via a posterior tympanotomy. The view of the round window membrane, however, is incomplete because of its orientation and the fact that it has a conical shape. Nevertheless, a good view along the basal turn is obtained after the antero-inferior overhang of the round window niche and the crista fenestrae have been removed. It might be damaging to drill away the postero-superior overhang as the osseous spiral lamina lies extremely close to the round window membrane.

The ultrastructure of mast cells found in normal inferior turbinate was compared with the features found in the inferior turbinate in two groups of patients, those with allergic rhinitis due to dust mite hypersensitivity and those with nasal polyps; the latter group also had their polyps studied. Adenoid tissue was examined in children with secretory otitis media to see if there was evidence of mast cell degranulation, which would support the hypothesis that either local allergic or other mast cell-mediated reactions caused the condition.

The mast cells from five normal turbinates varied considerably in size, shape and distribution, but were found mainly in the submucosa. There was no difference in the morphology of cells of different sizes and they could not be sub-grouped into either connective tissue or mucosal mast cells. Most. granules were electron dense and homogeneous, although scrolls and crystalline structures were seen occasionally. Some of the granules contained lighter material and others had become vacuoles. Mitochondria were present in all cells suggesting active metabolism.

The three patients with allergic rhinitis showed extensive but variable degranulation of the mast cells in all depths of the mucosa. Nine of the 10 cases with nasal polyps had mast cells identified in both the polyp and the turbinate. They were only normal in one turbinate and in one patient it was impossible to identify mast cells. All the mast cells were degranulated extensively in all other specimens.

The adenoids from seven children had identifiable mast cells, which were less frequently found than in the turbinates. There was some degranulation in four of the patients and in one it was fairly extensive.

It has been suggested that otosclerosis might be caused by a generalized disorder in the connective tissue.

The biophysical and biochemical properties of skin biopsies from twelve patients with otosclerosis and twelve age- and sex-matched controls were investigated. No differences were found in skin strength and extensibility, skin thickness, collagen content, the relationship between collagen type I and type III, reducible collagen cross-links and molecular stability of collagen type I of samples from patients with otosclerosis as compared with those from the controls. The present study does not support the suggestion that otosclerosis might be a generalized connective tissue disorder.

Preseptal (periorbital) cellulitis, subperiosteal abscess and orbital cellulitis are conditions which are still frequently seen in ENT, Ophthalmic and Paediatric practice. They are parts of the spectrum of the disease processes seen in the acutely inflamed orbit. The clinician should try and establish which of the three conditions the patient has, as both subperiosteal abscess and orbital cellulitis are more serious conditions than preseptal cellulitis.

There is still much confusion in the literature over the terms ‘periorbital cellulitis’ and ‘orbital cellulitis', and the terms are often used interchangeably. This makes an analysis of the literature with regard to the features of the conditions difficult. The introduction of the term ‘the acute orbit’ might possibly lead to less confusion ifitisusedto cover all inflammatory processes in the orbit. Descriptions, definitions and classifications of orbital inflammations have been given by many authors in the literature. There are many causes of the acute orbit, but sinusitis remains the commonest cause.

This paper considers the anatomy of structures contiguous to the upper pole of the thyroid gland. It also describes the findings of an anatomical dissection confined to the muscular andcarotid triangles of the neck with the nerves therein innervating the cricothyroid and infrahyoid muscles. The segmental nature of the latter is described. The variable course of the cricothyroid artery with regard to the sternothyroid muscle is noted. A superficially placed artery is accompanied by branches of the ansa cervicalis; a deeply placed one is related to the external laryngeal nerve.

In addition to the external laryngeal nerve there are other nerves, including branches of the ansa cervicalis, which can be damaged during operations involving the thyroid apex or adjacent structures. A comment is made about the significance of these findings with particular reference to voice change.

Otosporin and Gentisone HC ear drops were inserted twice daily for 3 weeks into the external auditory meatuses of guinea pigs. An intraperitoneal injection of vincristine (1 mg/kg.) was given to each animal three hours before it was killed. Temporal bones and attached external auditory meatuses were dissected, tissues were fixed in 10 per cent buffered formalin, decalcified in EDTA, and embedded in JB4 plastic for sectioning at 4 μm. The proliferative activity in the epidermis of the bony meatus and in the lateral surface of the tympanic membrane was obtained by deriving the mitotic indices. After both types of ear drops there was a statistically significant reduction in mitotic indices, the values being about half the control values. The proliferative activity in the tympanic membrane was too low to permit statistical analysis, but no differences were apparent between the groups. The thicknesses of the epidermis and dermis of the bony canal, and of the tympanic membrane, were measured using a Kontron MOP-AM03 analyser. Although the dermis was thinner as a result of the administration of ear drops, both the epidermis of the bony meatus and that of the tympanic membrane were thicker, all these changes being statistically significant.

The results of treatment of 124 cases of childhood cholesteatoma are reported in the present study and compared with an adult group of patients.

Intact canal wall tympanoplasty was performed in over 90 per cent of cases in children and the procedure was staged in nearly 80 per cent of cases.

The children had a 43.8 per cent incidence of residual cholesteatoma and an 8.8 per cent incidence of recurrent cholesteatoma in intact canal wall tympanoplasty cases.

Intact canal wall tympanoplasty remains the technique of choice in our hands for the treatment of childhood cholesteatoma; pre-planned staging of the operation is mandatory for the detection and elimination of residual cholesteatoma which occurs more frequently in children.

Anatomical characteristics of the hypotympanum were tested on 50 temporal bones. The hypotympanum has the shape of an irregular bony groove which is surrounded by five walls. The outer wall is formed by the tympanic part of the temporal bone. In 65 per cent of the cases the inner wall is formed by part of the petrous bone which extends under the promontory; in 25 per cent it is formed only by the lower part of the promontory; and in 10 per cent it corresponds to the juncture of the promontory and the petrous bone. The lower wall is clearly defined in 48.2 per cent of cases and corresponds to the juncture of its inner and outer walls. In 65 per cent of cases a recess of the inferior hypotympanic sinus is found on the floor of the hypotympanum. In 25.3 per cent of cases the jugular bulb protrudes into the tympanic cavity. In 73.4 per cent of cases the front wall is formed by part of the petrous bone which extends from its floor towards the tympanic opening of the protympanum, and in 26 per cent of the cases it is formed by the wall of the internal carotid artery. On the front wall, in 22.4 per cent of cases, a recess of the anterior hypotympanic sinus is found. The back wall is formed by elements of the styloid complex and in five per cent of the cases a recess or posterior hypotympanic sinus is found on it.

Twenty-seven patients with an initial diagnosis of otitis externa, untreated for the previous 2 weeks, were treated with weekly aural suction toilet and a choice of three topical drops. Two contained combinations of antibiotics and steroids, one of which also contained an anti-fungal agent. The third was boric acid in spirit. The patients were assessed at weekly intervals until a remission was established. From this study it would appear that antibiotic-based drops confer no real advantage over boric acid in spirit.

The ultrastructure of the normal human endolymphatic sac (ES) has been observed by transmission electron microscopy (TEM). The role of the epithelium, the various regions of the subepithelial space and the general anatomy of the ES in pressure regulation were morphologically studied to generate testable hypotheses of human ES function. Light microscopic (LM) and TEM evidence of pressure regulatory mechanisms by endolymph resorption, mechanical factors, and secretory activity are presented. These mechanisms may be useful in designing experimental studies of the ES, and in interpretation of retrospective LM and TEM studies of patients with Meniere's disease.

Anatomical characteristics of the fossula fenestrae vestibuli were tested and analysed precisely on 200 samples of temporal bones. The fossula is usually ovoid and shallow but can be, exceptionally, elongated, narrow and deep. It is surrounded by four walls. In 45.5 per cent of cases the upper wall is formed only by the facial canal and in 54.5 per cent of cases a bony lamella is found beneath the facial canal; the promontory forms the lower wall; the front wall is formed by the bony lamella and part of the processus cochleariformis; the back wall is clearly defined in only 22.8 per cent of cases and is formed by the bony lamella of the medial wall of the tympanic cavity. In 13.2 per cent of cases the floor of the fossula partially covers the prominence of the facial canal and in two per cent the eminentia pyramidalis. Bony recesses in this region occur fairly frequently: sinus subfacialis in 60 per cent, sinus retrofenestralis in 77.2 per cent, and sinus subrostralis in 25 per cent of the cases. These anatomical variations can influence the result of surgical intervention.