Anatomical characteristics of the hypotympanum were tested on 50 temporal bones. The hypotympanum has the shape of an irregular bony groove which is surrounded by five walls. The outer wall is formed by the tympanic part of the temporal bone. In 65 per cent of the cases the inner wall is formed by part of the petrous bone which extends under the promontory; in 25 per cent it is formed only by the lower part of the promontory; and in 10 per cent it corresponds to the juncture of the promontory and the petrous bone. The lower wall is clearly defined in 48.2 per cent of cases and corresponds to the juncture of its inner and outer walls. In 65 per cent of cases a recess of the inferior hypotympanic sinus is found on the floor of the hypotympanum. In 25.3 per cent of cases the jugular bulb protrudes into the tympanic cavity. In 73.4 per cent of cases the front wall is formed by part of the petrous bone which extends from its floor towards the tympanic opening of the protympanum, and in 26 per cent of the cases it is formed by the wall of the internal carotid artery. On the front wall, in 22.4 per cent of cases, a recess of the anterior hypotympanic sinus is found. The back wall is formed by elements of the styloid complex and in five per cent of the cases a recess or posterior hypotympanic sinus is found on it.

Anatomical characteristics of the fossula fenestrae vestibuli were tested and analysed precisely on 200 samples of temporal bones. The fossula is usually ovoid and shallow but can be, exceptionally, elongated, narrow and deep. It is surrounded by four walls. In 45.5 per cent of cases the upper wall is formed only by the facial canal and in 54.5 per cent of cases a bony lamella is found beneath the facial canal; the promontory forms the lower wall; the front wall is formed by the bony lamella and part of the processus cochleariformis; the back wall is clearly defined in only 22.8 per cent of cases and is formed by the bony lamella of the medial wall of the tympanic cavity. In 13.2 per cent of cases the floor of the fossula partially covers the prominence of the facial canal and in two per cent the eminentia pyramidalis. Bony recesses in this region occur fairly frequently: sinus subfacialis in 60 per cent, sinus retrofenestralis in 77.2 per cent, and sinus subrostralis in 25 per cent of the cases. These anatomical variations can influence the result of surgical intervention.

Sporadic case reports and the few published series of expanding lesions of the deep petrous temporal bone propose a variety of surgical approaches to ensure excision. All such surgery represents a compromise between exposure adequate for total removal and avoidance of further neurological deficit. Unfortunately pathology in the petrous apex evolves relatively silently and diagnosis is delayed. In many cases total excision is impossible. We present a series of patients presenting with advanced tumours of the deep petrous temporal bone in order to illustrate the spectrum of disease encountered, the limited role of surgery and the natural history of irresectable pathology in this remote and inaccessible area.

Vestibular Habituation Training (VHT) is the treatment of choice for paroxysmal positional vertigo (ppv). The origin of the disturbance is peripheral and the data observed in the cases treated confirm that it is not located in horizontal canal function. However, canal dysfunction can be present together with ppv. Usually a separate course is observed for the phenomena attributed to horizontal dysfunction and those to the ppv lesion.

The specificity of the Dix-Hallpike manoeuvres linked to the typical ppv is also confirmed by the data obtained by testing for VHT (VHT-test-battery).

Ppv can have a repercussion upon the vestibulospinal reflex. That the same ppv disturbance can coincide with normal as well as with abnormal posturographic data, pleads for the intervention of central adaptive mechanisms. The effect of VHT is due to stimulation of these central adaptive mechanisms and not to any impact upon the peripheral lesion.

The operation of submucosal diathermy is commonly performed for the relief of nasal obstruction due to mucosal swelling. In this study the effect of the procedure on nasal resistance to airflow is assessed by rhinomanometry. The results show that although the operation is effective in the short term (two months), there is no significant difference between the nasal resistances prior to surgery and at 15 months after surgery.

Twenty patients, 10 allergic and 10 non-allergic, with chronic hypertrophic rhinitis and presenting mainly with bilateral nasal obstruction were subjected to sub-mucosal diathermy of their inferior turbinates. There was significant post-operative improvement clinically, histopathologically and histochemically in the non-allergic group, while the improvement was less obvious in the allergic cases. The post-operative clinical improvement as regards rhinorrhea and sneezing was not as marked as that for nasal obstruction. Evaluation of the results showed that sub-mucous diathermy of inferior turbinates is a good line of treatment for cases of chronic hypertrophic rhinitis, with better results in the non-allergic group of patients.

The results of sinus aspiration in 100 children were analysed retrospectively. There was no correlation between a positive aspiration and the patients' symptoms, signs or previous radiograph.

A study of the effect of tonsillectomy on the frequency of sickle cell pain crises was carried out on 15 patients with sickle cell disease (Hb SS) who presented with complaints of frequent pain crises and were found to have chronic tonsillitis. They comprised 9 females and 6 males and ranged in age from 6 to 35 years, with a mean of 15 years. Tonsillectomy was performed under general anaesthesia. The mean number of pain crises in the one-year period after tonsillectomy was 1.5 and was significantly less than the mean number 4.7 in the one year preceding the operation (p<0.001). Four patients failed to show a reduced number of crises and these were those whose tonsils at operation showed no pus in their tonsillar crypts. It is thus observed that chronic tonsillitis, symptoms of which may not be volunteered at examination, is a potent inductor of sickle cell pain crisis and that tonsillectomy is an effective mode of treatment, especially when the tonsillar crypts contain pus.

Carcinoid tumour is one of the rarest middle-ear neoplasms. We describe here a case of carcinoid tumour of the middle-ear cleft that presented with aural as well as systemic symptoms. Diagnostic difficulty was encountered using light microscopy, but electron microscopy revealed the neurosecretory granules.

A case of acute renal failure associated with severe uraemic hearing loss is presented. Audiometric site-of-lesion testing revealed cochlear as well as neural involvement.

After therapy hearing recovered up to an almost normal level, with normal auditory nerve conduction velocities.

This case report supports the suggestion that the improvement of hearing after renal transplantation or dialysis might be correlated with the influences of these forms of therapy upon the peripheral neuropathy.

A man of 25 with von Recklinghausen's neurofibromatosis (VR) developed nasal polyps. Subarachnoid haemorrhage occurred shortly after surgical excision and he died 9 weeks later. Post-mortem examination showed chronic hydrocephalus due to aqueduct stenosis. Histologically the polyps were a nasal glioma, a forme fruste of anterior encephalocoele not previously associated with VR, though other cranial defects are well recognized. Nasal glioma should be considered in the differential diagnosis of nasal lesions in VR.

Chondrogenic neoplasms of the nasal cavity are rare. Clinically, presentation is often late, with expansion and destruction of the middle facial skeleton. Local radical surgical excision is the preferred treatment, with regular life-long follow-up. Risk of local recurrence and distant metastases may Qccur many years after initial treatment. All chondrogenic tumours should be carefully followed up because the natural course of the disease may not match the histological differentiation.

A parapharyngeal ectomesenchymoma consisting of mixed malignant fibrous histiocytoma and primitive neuroectodermal tumour with neuroglial differentiation occurred in a 36-year-old woman. Immunohistochemical and electron microscopic studies verified the combined mesenchymal and neuroectodermal components within the tumour. Only 9 similar cases, including the present one, are on record. The patients ranged in age from 6 months to 49 years, with an average age of 18 years. The male: female ratio was 4:5. The tumour location was widespread. All reported ectomesenchymomas were histopathologically malignant. Recurrence and/or metastasis was/were common. The neural crest has been suggested as the origin of the ectomesenchymomas.

An ossified segment of the stylohyoid ligament was misdiagnosed as a foreign body.