The terms ‘planned two-stage operations’, ‘planned second-look operations’, ‘previous surgery’, and ‘revision surgery’ are discussed on the basis of our series of 2,303 ears operated upon from January 1965 to December 1980. We have not performed any planned two-stage operations. All operations prior to the first operation in our department are denoted ‘previous surgery’. ‘Revision surgery’ denotes all reoperations performed either in this department or elsewhere during the observation period until the end of 1984, and the revision rate is analysed in patients with different pathological conditions. ‘Revision surgery’ was performed in 15.6 percent of 740 ears with cholesteatoma (in 13.9 percent once, in 1.6 percent twice, and in 0.1 percent three times), and ‘previous surgery’ in 3 percent.

Among 229 ears with chronic granulating otitis, revision surgery had been performed in 12.2 percent up to December 1982. By December 1984, this figure had risen to 16.1 percent. ‘Previous surgery’ had been performed in 18.3 percent. A total of 38.4 percent had at least two operations.

The revision rate in other conditions varied from 10 percent (sequelae to chronic otitis) to 34 percent (post-inflammatory acquired atresia). These rates are discussed and the functional results presented.

From 684 cases of ear surgery for cholesteatoma performed by one surgeon, 35 had labyrinthine fistulae (incidence 5.1 per cent). Of these fistulae, 79 percent involved the lateral semicircular canal only; the other sites involved were the other semicircular canals and the cochlea. The fistula test was positive in 54 per cent of cases overall, but in 80 per cent with an extended site fistula (ESF). Three surgical approaches were employed sequentially—staged combined approach tympanoplasty (CAT), open cavity tympanoplasty and attico-antrotomy. Surgically-induced deafness occurred in 3.3 per cent. All surgical groups showed similar hearing results, except for less conductive deafness in the CAT group. Surgical management is discussed with reference to current theories of the erosive effects of cholesteatoma.

In order to assess the extent of the underlying pathology in Bell's palsy, the vestibular function of 24 patients was evaluated within the first week from the onset of facial paralysis. Seven patients had pathological findings by ENG and an additional three had subjective vestibular signs; four of these ten patients also showed abnormal auditory brain stem evoked potentials. There was no correlation between the severity of the paralysis or the prognosis for recovery and the presence of vestibular abnormalities.

A technique of trans-septal approach to unilateral bony choanal atresia in the older child or adult is described with the advantages of better exposure, less bleeding and better mucosal cover of raw bone than traditional methods. This seems to reduce post-operative re-stenosis at the site of the atresia.

There are some cases in which mucocoeles of the paranasal sinuses are multiple and their structures are complicated. When the mucocoeles are multiple, pre-operative evaluation is especially important for correct surgical management. We describe the usefulness of computed tomography for the evaluation of multiple mucocoeles of the paranasal sinuses.

Sixty-five primary malignant laryngeal tumours, other than simple squamous cell carcinomas, treated at the Royal Marsden Hospital between 1949 and 1984 are presented. Of the 11 histological types pseudosarcomas (24 cases), verrucous carcinomas (9 cases) and lymphoreticular tumours (9 cases) predominated. Determinate three-year follow-up data were available in 50 cases. Sixteen patients (32 per cent) died of their neoplasms but survival was strongly related to histology. Only one death occurred among 24 determinate cases of pseudosarcoma and verrucous carcinoma. Radiotherapy was effective treatment for these two tumour types and for reticuloendothelial tumours. However, combined therapy yielded poor results with the other histological types.

We describe seven typhoidal tularemia patients without ulcers or lymphadenopa-thy, who underwent diagnostic bronchoscopy. Four patients had had obvious airborne exposure to F. tularensis during farming activities, and the remaining three had respiratory symptoms also. Bronchoscopical findings were pathological in all cases, varying from local to diffuse haemorrhagic inflammation; in one case a granulomatous tumour was seen. Early histopathological changes in three biopsies consisted of haemorrhagic oedema progressing to a non-specific inflammatory reaction, which could still be found 45 days after the onset of symptoms. Granulomatous inflammation, indistinguishable from tuberculosis or sarcoidosis, was seen in four biopsies from two patients, three to seven months after the onset. Most patients had radiographic hilar enlargement. We conclude that transmission of typhoid tularemia usually occurs through inhalation leading to bronchial changes, which correspond skin ulcerations in ulcero-glandular tularemia, the hilar enlargement corresponding to the lymph node component. We emphasize that usage of the term ‘typhoidal’ tularemia should be discontinued. Instead, tularemia transmitted through inhalation should be called pulmonary or respiratory.

We present two patients, mother and daughter, with a skeletal disorder of the skull, hearing loss and in one of them recurrent facial paralysis. In one patient middle ear exploration was performed. The malleus and incus were found to be fixed in the epitympanum.

The differential diagnosis is discussed. We reviewed all known hereditary conditions with hearing loss and musculoskeletal disease but we could not accept any of these diagnoses for our patients.

A case is described in which upper airway obstruction was successfully treated using cri-cothyroidotomy in association with high frequency jet ventilation. This procedure allowed time for the patient to be transferred to the operating theatre for formal tracheostomy under optimal conditions. It is suggested that the Portex ‘Mini-trach’ kit, though primarily designed for tracheobronchial toilet, can be used to provide a satisfactory and safe airway during the resuscitation of an obstructed patient, particularly if jet ventilation is available.