Until it is accepted that many of the recommendations for surgical treatment of middle ear disease, based on impressions formed twenty years ago, are misleading, attempts to rationalize the use of hospital resources will be little more than cosmesis. Responsibility for the initiation of cost-effective reform is primarily that of surgeons and requires urgent self-audit and the provision of realistic advice to patients (and administrators) as to what benefits microsurgery of the ear can offer.

This study investigated the effects of open-mastoid surgery upon ear canal resonance. In particular an attempt was made to alter resonant properties by obliterating each cavity with silastic foam. The results from this study showed that open-mastoid surgery significantly decreased resonant frequency without producing an effect upon either the peak amplitude or the quality of the resonant peak as defined by the Q-factor.

Restoring the natural resonance properties of an operated ear, if indicated, is likely to be a difficult objective to achieve in surgical terms.

Results of standard audiometry and tympanometry were compared with the Welch Allyn ‘Audioscope’ and ‘Microtymp’, in the diagnosis of secretory otitis media, in 100 children.

Standard pure tone audiometry had a specificity of 92 per cent and sensitivity of 51.6 per cent. The Welch Allyn ‘Audioscope’ a specificity of 84.2 per cent and sensitivity of 57.5 per cent; standard tympanometry a specificity of 71 per cent and sensitivity of 88 per cent; the Welch Allyn ‘Microtymp’ a specificity of 63 per cent and sensitivity of 90 per cent.

In view of cost, portability, and speed of testing the Welch Allyn instruments would be particularly suitable for community screening.

Pure tone audiometry with a pass threshold of 25 dB, at 2 and 4 kHz is a poor indicator of effusion.

Idiopathic subjective tinnitus (1ST) is one of the most obscure otological pathologies. This paper presents the results of treating 1ST by intratympanic instillation of lignocaine (lidocaine) 2 per cent through a grommet, for five weekly courses. Fifty-two patients suffering from intractable tinnitus entered this therapeutic trial, but only nine finished all five courses. In one patient, the tinnitus was almost completely abolished, but in all the nine patients the decompensated tinnitus changed to a compensated one. We suggest this mode of treatment for patients that were previously treated by drugs, acupuncture and biofeedback, with disappointing results.Patients should be warned about the side effects of vertigo and vomiting, which subsides gradually with every new instillation, and that the tinnitus may not disappear but will be alleviated, enabling them to cope more easily with the disease and lead a more normal life.

This study was set up, prospectively, to determine factors affecting the long-term hearing results of patients undergoing incus transposition as a second stage in ossicular reconstruction, following a successful drumhead repair in non-cholesteatoma ears. Seventy-one patients were entered into the study over five years from 1980–1985, 66 were available to be studied throughout the five year follow-up period.

Nine weeks post-operatively, 74 per cent of all patients has an air-bone gap of less than 15 dB (48/66). The type of first stage procedure had a significant effect on the hearing levels in the final five year assessment. The most successful sub-group were those patients who had a cortical mastoidectomy and silastic sheeting inserted in the first staging procedure. The air-bone gap, of less than 15 dB, was maintained in 71 per cent of this group (17/24). The sub-group who had a simple myringoplasty as the primary procedure had a good initial hearing level. By five years, however, only 30 per cent of the patients had maintained the air-bone gap of less than 30 dB (3/11).

The study reviewed the case histories of 14 young aphonies. A questionnaire was completed by the five speech therapists involved with these cases. The patients were all initially examined by E.N.T. specialists and then treated by speech therapy. All the patients were ‘cured’ by speech therapy, that is the voice returned to its premorbid state. This study looks at common characteristics of presentation, different approaches to management, and the patterns of voice return.

The serum concentration of four acute phase reactant proteins (haptoglobin, sialic acid, α, 1-antitripsin, ceruloplasmin) were determined in 160 patients with laryngeal cancer. In 50 cases treated by surgery serial determinations were performed. The control group included healthy persons and patients with non-neoplastic diseases. The levels of haptoglobin, α 1-antitripsin and sialic acid were significantly higher in cancer patients than in control group. The levels of ceruloplasmin reveals no statistically significant difference between particular groups of patients. The serum concentrations of haptoglobin, α 1-antitripsin and sialic acid correlated with the clinical status of cancer patients. We suggest that serial determination of certain acute phase reactant proteins may be useful as a prognostic acid in following patients with laryngeal carcinoma.

Nucleolar organizer regions (NOR) were studied in 15 salivary gland myoepitheliomas by an argyrophilic staining technic (AgNOR). The AgNOR data were then compared with flow cytometric DNA content of the neoplasms and also with selected clinicopathologic parameters. We conclude that AgNOR's: (1) do not correlate well with DNA cytometric indices and (2) at best, provide redundant information.

Four regimens of prophylactic antibiotics were utilized in 122 consecutive patients of stages III and IV carcinoma of the upper aero-digestive tract undergoing major resections in a randomized single-blind study. Ampicillin, gentamicin, cephalexin and metronidazole were used in different combinations for periods of 5 or 10 days. A cephalexin-metronidazole protocol for 10 days was associated with lowest post-operative infection rate. Oral-oropharyngeal resection and use of pectoralis major myocutaneous flap were the most important factors contributing to infection.

A recent innovation in the technique of tracheostomy is now available as a commercial kit. A standard tracheostomy tube is inserted using a guidewire and dilator as in the Seldinger technique. The kit was used in nine cases in a unit with a head and neck oncology interest. Two failures were experienced but no serious or fatal complications. The technique is limited when applied to necks which are not anatomically ‘ideal’, and hence will have application in head and neck surgery only after careful patient selection

We present a rare case of a transitional papilloma of the middle ear, occurring several years after excision of a similar lesion from the nose. There was no continuity between the two lesions suggesting that these tumours can be multicentric in origin.

A salivary gland choristoma is an extremely uncommon tumour in the middle ear space. It appears to be a developmental abnormality and may be associated with abnormalities of adjacent structures.

It usually presents with unilateral conductive deafness which may be long–standing and the tumour often pursues a benign, slow growing course. It is usually possible to excise it, but problems may arise as there may be variable associated anatomical abnormalities of the middle ear.

We present the nineteenth recorded case, review the literature and discuss the management of this condition.

Two patients with laryngeal stridor secondary to myasthenia gravis are reported. The cause of bilateral abductor weakness in myasthenia is discussed; anticipation of the stridor in myasthenic patients is highlighted.

A case of metastatic laryngeal paraganglioma is presented. We have reviewed the current world literature on this entity and thereby identified two apparently distinct types of this rare lesion (type I and type II).

The histopathological features are unhelpful in discriminating these two types and this is instead based on clinicoepidemiological differences. The latter are annotated and discussed with respect to prognosis and management. A true estimate of the frequence of type II (potentially malignant) awaits the utilization of the recent improvements in diagnostic. techniques.

Cowden's disease is characterized by multiple hamartomas and neoplasias of ectodermal, mesodermal and endodermal origin. A case of a 22-year-old man suffering from nocturnal dyspnoea is reported. The patient had a large number of hyperkeratotic, lichenoid papules, scattered over the right side of the trunk, back and palm. In his oral cavity, papules were present on the gingiva and hard palate. The patient was operated on for tonsillar hypertrophy and for excluding the possibility of malignant lymphoma. An examination of immunophenotypes of the palatal tonsil lymphocytes revealed B-cell proliferation and poly-clonal immunoglobulin.

The authors describe a rare case of plexiform neurofibroma of the cervical portion of the vagus nerve, and discuss its aetiopathogenesis, clinical, histological and therapeutic features, emphasizing the difference from other benign tumours of the vagus nerve.

The clinical characteristics of the mass, ultrasound tomography, CT scanning and digital subtraction angiography were useful in defining its extension and relationships with the surrounding structures.

Surgery is the treatment of choice. After mentioning the most commonly employed surgical approaches, they emphasize the advantages of the lateral-cervical approach which allows a wide exposure of the possible sites of origin of the tumour and its complete removal.

Finally they stress the need of an accurate histological and immunohistochemical examination in order to differentiate neurofibromas from neurilemmomas.

We report two cases of terminal duct carcinoma of the minor salivary glands. The histological features, biological behaviour, treatment and the long-term management are described.

A case of malignant pleomorphic adenoma of the left parotid gland which metastasized to the kidney and multiple subcutaneous sites is presented. The patient presented as an acute emergency due to spontaneous rupture of the kidney containing metastasis. All the distant metastatic lesions were confined to the right side of the body.