Brush biopsies from the middle-ear (ME) and nasal mucosa were taken from a 4-year-old girl with complete situs inversus, recurrent otitis media and tonsillitis, who underwent tonsillectomy, adenoidectomy and bilateral myringotomy with insertion of ventilation tubes. Ciliary beat frequencies (CBF, Hz.) of the ME and nasal samples, measured by a photoelectric system equipped with a fiber-optic probe, were 9.5 Hz. (±1.2) and 13.7 Hz. (±4.1) respectively. These values are similar to CBF of nasal samples obtained from normal subjects. In vitro CBF assessment is a useful investigative tool for the study of mucociliary activity in the ME, as in patients suspected to have ciliary dyskinesia syndrome.

Eight patients receiving prolonged treatment with gentamicin for bacterial endocarditis were monitored for possible ototoxicity using transtympanic electrocochleography as an adjunct to pure tone audiometry, vestibular function tests and serum gentamicin levels. An immediate effect of intravenous gentamicin on the cochlea, shown by changes in the whole nerve action potential and/or cochlear microphonic was recorded in seven patients, none of whom had experienced vestibular or auditory symptoms with gentamicin prior to testing. Two patients subsequently developed evidence of vestibular dysfunction, and a high frequency sensorineural hearing loss occurred in a third individual. There have been no previous report of the immediate effects of gentamicin on the human cochlea to date. The significance of these findings in routine clinical monitoring of ototoxicity is discussed in the light of clinical and animal evidence for the possible mode of action of aminoglycosides on the auditory and vestibular apparatus.

During adeno-tonsillectomies performed under general anaesthesia with N2O we observed and measured a serious increase in middle-ear pressure (M.E.P.). This is due to the fact that the rate of diffusion of N2O is greater inwards than outwards. This rise in the middle-ear pressure is due to the packing of the nasopharynx after adenoidectomy for haemostasis.

Abstract Twenty-six patients with secondary or early latent sypilis were examined by auditory brainstem reponse (ABR) audiometry and by pure tone audiometry before and after treatment. Normalization was registered in four of seven patients with pathological ABR before treatment, while in three patients the ABR abnormalities remained after treatment. Thirteen patients exhibited a sensorineural hearing-loss before treatment. In two patients this hearing-loss improved after treatment and a syphilitic etiology seems plausible. The reversible lesions in the auditory system may be related to asymptomatic syphilitic meningitis. Permanent ABR abnormalities might reflect syphilitic vascular involvement in the brainstem.

To allocate sufficient resources to clinical services or to research and development in the most effective way possible, statistics are needed on the prevalence of the condition in question for various degrees of severity. For the United Kingdom, such data for tinnitus have become available from two recent large-scale studies. The first is the National Study of Hearing (NSH) which is being conducted by the Medical Research Council's Institute of Hearing Research from its headquarters in Nottingham and its clinical outstations in Cardiff, Glasgow, Nottingham and Southampton. It started in 1978 and is now entering its third phase. The second study is the General Household Survey carried out in 1981 by the UK Office of Population Censuses and Surveys (OPCS). The rationale and methodology of the NSH and the prevalence data obtained up to the present, together with those from the OPCS survey, will be given in this paper; the demographic data and the clinical aspects of the study will be presented in the accompanying paper (IHR, 1984).

Previous studies havd shown erythromycin to penetrate into both the middle-ear effusion and the adenoid tissue in children with Otitis Media with Effusion (OME). The levels obtained were similar to the plasma levels. Cultures in long-standing cases of OME have yielded respiratory pathogens—Haemophilus influenzae, streptococcus pneumoniae and Branhamella catarrhalis—in the nasopharynx in 79 per cent and in the middle-ear effusion in per cent.

In the present investigation a group of children with OME of more than three months' duration were given erythromycin (Abboticin®) in standard dosage for the last 10 days prior to scheduled operation (paracentesis or tympanostomy). Resolution was determined as normalization of the middle ear status, and this led to cancellation of surgery. The rate of resolution—12/26 (45 per cent)—was significantly higher than in a similar group of children not treated with erythromycin—11/72 (15 per cent). There are thus rational reasons for using erythromycin in OME, in many cases as an alternative to tympanostomy.

A double-blind placebo controlled trial of Mucodyne (carbocisteine, Berk Pharmaceuticals), Actifed (triprolidine HCI and pseudoephedrine HCI, Wellcome) and combined Mucodyne and Actifed in the treatment of middle-ear effusions is reported. The trial was undertaken to assess whether either preparation, alone or in Combination, would reduce the number of children requiring surgical treatment for this condition. No statistical difference between the various groups in avoiding surgical treatment with Mucodyne was associated with a significantly greater number of ears restored to a normal appearance and middle ear function as measured by tympanometry. All patients relapsing after surgery belonged to the groups receiving placebo, Actifed or the combination of Mucodyne and Actifed prior to the operation.

A study of 43 cases of inverted papilloma of the nose has been made. These cases, arising from a moderately well-defined geographical area, were seen between 1955 and 1980. A detailed clinical and histological review was made in each case. No correlation has been found between any of the variable histological features and the potential of a particular popilloma to recur. The overall incidence of transformation to carcinoma is low, even after multiple recurrences. The findings suggests that there may be an extrinsic factor contributing to the causation of these tumours.

Active chronic otitis media affects 0.5 per cent of adults and has two main variants. The first is when there is a squamous epithelial retraction pocket or cholesteatoma. The second variant is when the disease is primarily of the mucosa of the middle ear and mastoid air-cell system. Classically a cholesteatoma is considered ‘unsafe’ because of the risk of complications, particularly intracranial infectioa Mucosal disease, on the other hand, is considered ‘safe’ because complications are thought to be rare. Surgery in the form of a modified radical mastoidectomy is considered to make active chronic otitis media ‘safe’.

A retrospective review of 26 consecutive brain abscesses considered secondary to active chronic otitis media revealed that a cholesteatoma was present in 12 (46 per cent), mucosal disease in 10 (38 per cent) and a modified radical mastoidectomy had been performed in four (15 per cent). Mucosal disease and a modified radical mastoidectomy should no longer be considered ‘safe’. However, the risk of developing an intracranial abscess from any type of active chronic otitis media is low, in the region of one in 3,500.