The ultrastructure of the guinea pig endolymphatic sac was studied, using the ruthenium red staining technique. The dye stained the apical cell surface coat and the homogeneous substance in the luminal space of the endolymphatic sac, when introduced from the luminal side of the epithelium. It is suggested that the surface coat and homogeneous substance may play an important part in the endolymph regulatory mechanism in the endolymphatic sac. When ruthenium red was introduced from the subepithelial side, the basolateral surface of the epithelial cells usually became brightly stained in the absence of staining of the apical cell surface, due to the presence of the tight junctions. In some instances, however, the dye penetrated beyond the level of the tight junctions. Pinocytotic vesicles and larger vacuoles in the epithelial cells were also sometimes stained, both apically and near the lateral cell surface. These findings suggest that endolymph efflux mechanisms in the endolymphatic sac may involve the combined actions of a paracellular and transepithelial flow as well as a transcellular, vacuolar bulk flow.

This paper presents the results of a pilot study of vaccination in thirteen patients with chronically infected mastoid cavities or central perforations of the tympanic membrane. In each patient Pseudomonas aeruginosa was repeatedly cultured from the ear and a long list of medical and surgical treatments had been tried, without success, to control the infection. The clinical, bacteriological and immunological responses were monitored over a six-month period.

The results are extremely encouraging. Eight patients' ears became dry for the first time in many years. However, three months after vaccination three ears had become reinfected.

All of the patients except one had a good immunological response to vaccination, with many-fold increases in the total serum immunoglobulin G, A and M levels.

We present a study of 22 patients with perennial non-atopic rhinitis who have been treated with a course of topical beclomethasone diproprionate (Beconase). All subjects were skin-test negative for the common inhaled allergens and had normal total and specific IgE levels. The results of treatment were assessed by symptom scoring and by active anterior rhinomanometry, and are compared to measurements of resistance made in 22 untreated controls and an equal number of normal volunteers.

A scanning electron microscopic study of the endolymphatic sac of the mongolian gerbil is presented. As described in other animal species and in man. three rather distinct regions on the epithelial surface can also be recognized in this rodent. Light and dark cells are seen to line the sac epithelium throughout. At the level of the intermediate portion, however, a different cell-type—the granular cell—is present, with its luminal surface covered by large amounts of solid material.

On the basis of light and transmission electron microscopic studies presented elsewhere, a higher degree of functional specialization in this portion of the gerbilline sac is proposed.

Cushing's syndrome due to the abuse of Betamethasone nasal drops has not been described before. This report presents such a case and emphasises the care which oe must take in prescribing topical sterioids.

Tympanometry and acoustic reflex tests performed on 431 school children aged five to six years showed that eight per cent of the ears screened had type B or type C tympanograms suggestive of otitis media with effusion (1.2 per cent type B, and 6.8 per cent type C). Preliminary otoscopy revealed tympanic membrane appearances consistant with middle ear effusion in a correspondingly low proportion of ears (7.6 per cent), whilst acoustic reflex screening at 105 dB for three frequencies (0.5, 1 and 2 kHz) showed absent reflexes at one or more frequencies in 8.1 per cent of the ears. The findings indicate a relatively low prevalence of otitis media with effusion in children in Nigeria. Possible contributory factors are discussed.

Fragments of otospongiotic and otosclerotic footplates were investigated by immunohistochemical methods. Antibodies IgG, IgA, IgM were found to be found to the vascular connective tissue of the resorption lacunae, IgG also to osteocytes. The application of antibodies against mumps, measles and rubella antigens showed the expression of the relevant viral antigens in the large cells of the resorption lacunae, in the vascular connective tissue, and in osteocytes, osteoclasts and chondrocytes, present in or around the otospongiotic areas. In the sclerotic stage only the perivascular connective tissue and chondrocytes have expressed viral antigens whereas IgG was restricted to the osteocytes of the sclerotic focus and to the residual perivascular tissue. Two footplates with postinflammatory sclerosis serving as controls revelaed only IgG in some chondrocytes. Healthy footplates showed neither a deposition of antibodies nor any expression of viral antigens. These results favour a viral aetiology of otosclerosis as an inflammatory vasclar reaction of the otic capsule initiated or caused by the viruses of measles, rubella and mumps.

Thirty-six children with bilateral secretory otitis media were treated by thermal myringotomy and middle ear aspiration in one ear, and conventional myringotomy, middle ear aspiration and Shepard grommet insertion in the other ear. All children underwent adenoidectomy. Comparing the effectiveness of the two different procedures over a three-month review period, our main findings are as follows. All thermal perforations were closed by 42 days. Elimination of middle ear fluid was achieved in 81 per cent of the thermal myringotomy group, and in 100 per cent of the grommet group. While there was no significant difference in the hearing improvement between the procedures, conventional myringotomy and grommet insertion provided significantly better sustained middle ear ventilation.

Topical nasal phenylpropanolamine in a 2.5 per cent solution (PPA) was used in an evaluation of the possible development of tachyphylaxis and of possible effects on the mucociliary system after one week of treatment in healthy humans. The tendency of PPA to produce tachyphylaxis was evaluated by rhi-nomanometrie measurements of nasal airway resistance after repeated dose-response provocations. The mucociliary transport time was tested with the saccharine-dye test. No reduced dose-response effect or change in mucociliary transport time was found with PPA, thus indicating that one week of treatment does not contribute to such adverse effects.

Mechanical ventilation is now widely used in neonatal intensive care. Methods and materials for endotracheal intubation vary between intensive care units. Up to eight per cent of ventilated infants may have subglottic stenosis after discharge from hospital (Jones et al., 1981).

Small chemodectomas in the middle ear cavity can be recognised by otoscopy, but only radiology will show i f the jugular bulb is involved. This assessment can be difficult, but largely governs the surgical approach. Magnetic resonance is a valuable adjunct to CT, providing some tissue characterisation. The relative value of various imaging techniques is discussed.

Historically, tracheostomy has been performed from about the first century, and instruments were devised to carry out such a procedure. Relief of airway obstruction was later facilitated by instruments to perforate the cricothyroid membrane and at the turn of the century, O'Dwyer introduced an instrument to allow blind intubation of the larynx with a metal cannula. Direct visualization of the larynx for the purposes of diagnosis and treatment was effectively delayed until general anaesthesia became available, and early laryngoscopes and bronchoscopes were hampered by poor illumination and difficulty in maintaining oxygenation. The invention of fibreoptic lighting overcame the former problem to a large degree, but easy maintenance of oxygenation and anesthesia during bronchoscopy has been revolutionized by the invention of rigid ventilating bronchoscopes.

Two cases are presented, both patients with advanced maligant otitis externa.

The antibiotic ciprofloxacin has strong anti-pseudomonal activity. It was given orally for six months to both patients, following administration of the traditional parenteral antibiotic courses, and in each case the disease has been extinguished. We therefore recommend that the management of patients shown to have malignant otitis externa should include strict diabetic control, regular local aural toilet, gentamicin ear drops and a six week course of parenteral antipseudomonal antibiotic agents (usually gentamicin and azlocillin) together with metronidazole to cover any anaerobic element in the infection. This regimen should be followed by a six month course of oral ciprofloxacin (750 mg b. d.). Indium scans should be used to monitor recovery. We believe that this regimen can significantly reduce the morbidity and mortality of patients suffering from malignant otitis externa with cranial nerve involvement.