Abstract Eighty-eight patients from 16 to 79 years old, with acute purulent otitis media, were bacteriologically examined at the Otorhinolaryngology Department of a primary care hospital in Tokyo from July 1979 to May 1983. Fifty-six patients underwent paracentesis, and 32 patients exhibited otorrhea due to previous spontaneous perforation of the tympanic membrane.

Bacteriologic cultures revealed the presence of Streptococcus pneumoniae (62.5 per cent), including S. pneumoniae Type III (28.1 per cent), Haemophilus influenzae (10.5 per cent), Staphylococcus aureus (11.5 per cent), and Streptococcus pyogenes (7.3 per cent). S. pneumoniae Type III had a notably high detection rate in patients from 50 to 79 years old (50–75 per cent). Because Haemophilus influenzae was detected at a relatively high rate in patients of all ages, if can be considered as a was detected at a relatively high rate in patients of all ages, if can be considered as a major causative pathogen of AOM.

In 44 patients, selected mainly from those who underwent paracentesis, a comparative study of bacteria found in middle ear fluid and naso-pharyngeal mucus revealed the same nacteria in 43 out of 44 cases. (97.7 per cent), indicating the presence of bacterial infection through the auditory canal.

Antibiotics were selected according to an Expected Efficiacy Index (EEI), the antibiotic of first choice being Ampicillin or Cefaclor.

Transdermal scopolamine medication has been evaluated in 30 cases of acute peripheral vertigo. The double blind study revealed favourable effects, e.g. in Menière's disease. The best compromise between effect and side-effects was one active medication patch. The side-effects were those described for scopolamine, such as blurred vision and dryness of the mouth. Transdermal scopolamine seems to offer an alternative form of medication in acute peripheral vertigo.

The relationship between serum lidocaine levels and tinnitus relief was assessed in 5 patients during intermittent intravenous infusions of the drug. Experiments were conducted under controlled conditions in that neither the attending physician nor the patient was aware of whether active drug or placebo was being infused at any particular time. A significant relationship between serum level and effect was observed in two patients. In the remaining patients this relationship was not readily apparent but there was still a trent for a better response to be seen at higher levels. A satisfactory response was generally seen at levels above 1 μg/m1. The results are consistent with the hypothesis that the transient nature of the symptomatic relief caused by lidocaine is related ot the fast clearance of the drug from the body.

The success rate of eighth nerve section in abolishing tinnitus is disappointing and the results generally unpredictable. A comparison of the effects of a bolus intravenous injection of lidocaine with the effects of nerve section is reported: it presents some evidence that the response to lidocaine may be of value in selecting patients for nerve section, and further it may shed some light on the site of action of lidocaine in suppressing tinnitus.

In the preceeding report (Jackson, 1985) the author produced evidence which brought into question the widely held view that, in abolishing tinnitus, lidocaine was acting ‘centrally’. This present investigation is another approach to attempt to narrow the site of action of lidocaine in abolishing tinnitus.

During a four-year period, patients suffering from strictly unilateral tinnitus which was referred to, and therefore apparently arising from, an ipsilateral ‘dead’ ear, underwent electrocochleography. Additionally, the subjective effect on the tinnitus of a bolus injection of lidocaine was recorded. Nine patients were available for this study, which appears to show a correlation of the results of the elec-trocochleogram and the effects of the lidocaine injection, although the numbers are small.

The phenomenon of a position-dependent fluctuation of hearing loss, in patients subsequently found to have perilymphatic fistula, is reported. Eleven patients with rupture of the oval or round windows of the labyrinth showed a lowering of thresholds on audiometry after lying horizontally for 30 minutes with the affected ear uppermost. It is suggested that air had entered the membranous labyrinth, interfered with transmission of footplate vibration to the perilymph column, and was displaced by this manoeuvre to produce a small, measurable, hearing gain, The diagnostic and prognostic significance of this finding is discussed.

Brain stem auditory evoked potentials (BAEP) and the blink reflex (BR) were recorded from 50 patients with a wide spectrum of multiple sclerosis, to determine whether the combination of the two tests of brain stem function would yield a higher rate of abnormality than each test performed alone. Sixty-four per cent of patients had a BAEP abnormality and fifty-two per cent had an abnormal BR, but when the results were combined, seventy-six per cent were abnormal. The blink reflex was abnormal in all patients with symptoms suggestive of trigemino-facial pathology.