Twelve deaf adults and two deaf children were treated with the Ineraid (formerly Symbion) four channel intracochlear implant between September 1989 and October 1991 at Addenbrooke's Hospital in Cambridge. All were post-lingually totally deaf and had found themselves beyond the reach of hearing aids. The effect of the implant upon the patients ability to lip-read was tested with the speech tracking test, BKB sentences (comparable to CID sentences) and Boothroyd word lists (comparable to NU6 word lists). All patients showed an improvement in their ability to understand speech with the help of the implant. Discrimination of speech without lip-reading was tested with Boothroyd word lists and BKB sentences, eight patients (57 per cent) demonstrated some ‘open set’ speech discrimination. The acceptability of the carbon percutaneous pedestal is discussed from the patient's, audiologist's and surgeon's points of view.

A prospective study was undertaken of 10 chronic renal failure patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) complicated by repeated bouts of peritonitis treated with gentamicin. Each 10-day treatment course consisted of a 120 mg loading dose, followed by 16 mg in 21 of peritoneal dialysate, given four times a day. Serum gentamicin analysed by enzyme immunoassay showed a mean level of 5.2 µg/ml, (range 3.7 to 6.6 µg/ml) four hours after the loading dose. Similar levels, well within the therapeutic range, were maintained on the 3rd, 5th, 7th and 9th days of intraperitoneal gentamicin therapy, suggesting no accumulation of gentamicin in the serum. Pure tone audiometry, electronystagmography and clinical assessment were performed during each course of treatment. Although no evidence of ototoxicity was found during the first two courses of gentamicin, but disequilibrium and bobbing oscillopsia were present during the third and fourth courses of gentamicin. These findings could be explained by cumulative injury to the vestibular apparatus caused by repeated therapeutic insults.

Concern about the possible risk of viral infection being transmitted by the use of homografts has renewed interest in cortical bone autografts as an ossicular substitute. Over the last four years I have used cortical bone on a regular basis. Comparison of hearing results obtained using ossicular and cortical bone grafts shows no significant difference between the two groups. Cortical bone appears to be satisfactory material for ossiculoplasty, but long-term studies of outcome are required to confirm this.

The masses of preserved ossicles and cortical bone grafts have been studied in vitro using a Stanton Unimatic CL41 balance. The cortical bone grafts prepared for use in malleus-stapes assemblies had a mean mass 28 per cent greater than that for an incus, while those prepared for use in a malleus-footplate or drum-footplate assembly had a mean mass 58 per cent greater. Analysis of the hearing results for the first 20 ossiculoplasty operations performed by the author using cortical bone grafts revealed no significant differences in outcome attributable to increased mass. However, large grafts did become fixed to surrounding structures in some cases.

This paper describes the results of a comparative audit of the costs of using artificial prostheses and cortical bone. The costs of using a bone graft have been calculated by estimating the expenses incurred as a result of the additional time required for preparation of the grafts. The mean cost of preparing a graft was £29.10, while the mean cost of using a prosthesis was £65.01.

This paper offers an account of the contemporary surgical approach to advanced tumours of the external ear based on a series of 11 patients. There were eight squamous, two basal cell carcinomas and one mucoepidermoid tumour. The traditional method of excision was slightly modified by performing microsurgical dissection of the lateral part of the temporal bone rather than chisel osteotomies, and then including it en bloc with the involved soft tissues. The defect was then closed using a scalp or myocutaneous flap and this combination of otological and reconstructive expertise has proved satisfactory. Four patients are alive with no evidence of disease a mean of 4.2 (range 1.0–7.0) years from surgery: two patients who remained free of disease have subsequently died of unrelated conditions 12 and 24 months post-operatively, and in three cases death from recurrent disease occurred a mean of 1.4 (range 0.9–2.1) years after our surgery. There were two postoperative deaths. Based on the actuarial survival of 36 per cent and a successful disease clearance rate of 54 per cent, our conclusion is that the outlook of this condition has not dramatically improved since the original descriptions of the management of this problem first appeared, although intervention remains justifiable because of the potential curability and relief of symptoms.

Adenotonsillectomies are performed increasingly as day cases in North America and Canada. This paper analyses reports where such tonsillectomies were performed. It is possible to successfully select a group with lower risk of complications. Haemorrhage occurs either early in the post-operative period or later than 24 hours after operation. With good organization tonsillectomies can be safely performed as day cases.

Tonsillectomies have been performed on a same-day basis in Coventry for the past three years. We report our experience with this technique which has gradually evolved over the last ten years. The procedure is described in detail and the results of the first two years have been analysed. In common with the experience of others, it is possible to perform tonsillectomies safely on a same-day basis.

Parents of children undergoing (adeno) tonsillectomy were questioned about their preferences for a period of hospitalization. The proportion wanting early discharge increased as their children recovered after surgery.

The use of diathermy to achieve haemostasis after tonsillectomy remains controversial. We have reviewed the English language literature, and found no convincing evidence that diathermy is any more likely to cause post-operative haemorrhage than the use of ligatures. The results of a prospective, randomized study of 1036 consecutive tonsillectomies are presented. No significant difference was found in post-operative haemorrhage rates when either diathermy or ligatures were used. Diathermy was found to reduce operating time compared to ligatures. The possibilities for day-case tonsillectomy are discussed.

We investigated the DNA ploidy patten in thirteen primary and four recurrent rhabdomyosarcomas of teh head and neck from thirteen adult patients and conrrelated the findings with other clinicopathological factors and clinical outcome. Twelve (92.7 per cent) of the primary neoplasms manifested an aneuploid DNA pattern. All recurrent lesions were DNA aneuploid with DNA indices (DIs) Corresponding to their primary neoplasms. No correlation beteween the ploidy pattern and histological subtypes, tumours location, clinical stage and patient's clinical course was found. In this study, only two patients were long-term, survivors. Both patients had stage I neoplasms that were located in non-parameninigeal sites which manifested an alvellar histological pattern. Our data indicate that adult rhabdoyosarcomas of adult and neck are preponderantly DNA aneuploid and are highly aggressive malignant neoplasms. Our results alson suggest that tumours which are low stage and in a non-parameningeal location may pursue a less aggressive course.

The performance of various specialzed and general purpose drills was assessed for use in temporal bone dissection. The Minicraft MB120 and MB130 were found to be as effective as specialized drills but with grater convenience and much reduced cost. The use of these drills allows high quality temporal bone dessection to be performed on a limited budget.

A new surgical technuque for the tratementof mederate to large hypopharyngeal diverticula is described, The procedure particularly useful in debilitated patients that it is quick and guarnties closure of the party wall between the pouch and upper oesophagus.

Meningitis may be the sole presenting sign of a cerebrospinal fluid (CSF) fistula of the temporal bone. An eight-year-old boy suffering from recurrent meningits was found to hav ebilateral severe cochlear dysplasia. Bilateral tympanotomies were performed, planning to obliterate each vestibule. In the right ear a stapedectomy was oerfirned, resulting in terrntial ‘CSF gusher’ and difficulty in packing the vestibule. CSF rhinorrhoea requiring revision surgery and twon episodes of gram-negative bacterial meningtis complicated the post-operative management, resulting in a prolonged hospital stay. Subsequently, the left ear was managed in a different fasion, leaving the stapes in situ, with grafts placed to seal the oval window nche. We would recommended this alternative procedure in cases of severe cochlear dysplasia, where abnormalities of the vestibule and basal turn of the cochela mean that performing a stapeddectomy to pack the vestibule may result in a severe ‘CSF gusher’, by opening directly into the subarachnoid space.

Bilateral facial palsy is an uncommon condition and few clinicians have experience of more than the occasional case. Unlike its unilateral counterpart, an aetiological, factor is often demonstrable. A Wide variety of recongnized disease may give rise to the condition and thus thorough investigation is required. This paper presents an unusual example of this rare condition.

A case report of a rare tumour, not yet documented at this site, showing a characteristic histological appearance is described.

A case is reported in which a patient presented, 18 months after initial injury, with a progressive proptosis of the left eye. X-rays did not reveal a foreign body but a fracture of the lateral orbital wall and an area of soft tissue density were seen on the CT scan. Exploration of the orbit revealed a 2 cm wooden fragment in the floor of the orbit.

The clinicopathological features of a rare case of osteoblastoma of the nasal cavity arising from the nasal turbinate are reported and compared with four reported cases of osteoblastoma with nasal cavity involvement. Two of the five tumours involved the nasal cavity and paranasal sinuses. The remaining three tumours were confined in the nasal cavity; one arose from nasal bone and two from nasal turbinate periosteum. Four tumours were successfully treated with local excision. One tumour recurred locally after excision; the recurrence was apparently controlled by further local excision.

The paranasal sinuses are a rare site for tumours of myogenic origin. There has been only one previously reported case in the English literature. We present a case of a leiomyoma filling the anterior ethmoid sinus and middle meatus which was excised via a Patterson's external ethmoidectomy.