While otitis media is perhaps the most common disease of childhood that receives medical attention, there is little agreement concerning the efficacy of the medical and surgical therapies employed to try to alleviate its symptoms or hasten its natural resolution. Because various surgeries including adenoidectomy, myringotomy, and insertion of tympanostomy tubes are frequently involved in the treatment of otitis media with effusion (OME), it is likely the most expensive condition being managed in national terms.

In an attempt to elucidate the most appropriate management of this condition, a meta-analysis was attempted to the 12 randomized control trials of surgical treatments for OME in children, published between 1966 and 1990. Heterogeneity both in the populations and comparisons studied and in the out comes presented made meta-analysis an inappropriate method for clarifying this area of clinical uncertainty. Important elements in the design of randomized control trials that should be included in future studies of treatment for OME are therefore discussed.

Cholesteatoma in children presents characteristics that differentiate it from the adult condition. Surgery has been performed in 55 ears. The main reason for referral was otorrhoea (83 per cent), either alone (29 per cent) or with hearing loss (54 per cent). Apart from three cases with an intact eardrum, a perforation was always present mostly posterior-superior (50 per cent). Open techniques were performed in 27.3 per cent of the ears and the closed technique in 72.7 percent. Only in 18 per cent of cases was the ossicular chain normal and mobile. The attic was occupied by cholesteatoma in 79 per cent. Recurrence took place in 37 per cent and 13 per cent of the closed and open techniques respectively. Open techniques tend to be employed in the presence of extensive disease, whereas the closed technique is reserved for those with a more localized problem.

A prospective study was designed in which General Practitioners were issued with a standard referral letter for hearing aid provision. Unknown to the General Practitioner an independent otolaryngologist assessment was obtained at the time of first attendance. Three hundred consecutive patients selected by General Practitioners applying these guidelines were seen in a designated hearing aid clinic staffed by audiological technicians of senior grade or above. Referral pro formata were incomplete in 75 patients who were not assessed. Ninety-four patients (31 per cent) (95 per cent confidence interval 29–36 per cent) were accepted by the audiologist. Obstructing wax was the most common criterion failed. Clinical agreement between audiologist and otolaryngologist was 57 per cent greater than chance. None of the cases of clinical disagreement altered treatment. A direct referral system as proposed could have processed only 31 per cent of 300 referrals. However, experienced technical staff reliably detected otological pathology and with aural toilet facilities 91 per cent of 225 patients (confidence interval 88–94 per cent) were aided.

Patients with a conductive hearing loss may find conventional hearing aids unsatisfactory for a variety of reasons. Efforts to overcome some of these difficulties have led to the development of the osteointegrated hearing aid.

Implantable bone conduction hearing aids are an important advance in the treatment of well selected patients. Only 18 patients, who have been implanted with the Xomed Audiant bone conduction hearing aid, have so far been reported on in the UK. This report concerns a further six patients who have been implanted in one centre.

Five of these patients continue to use their Audiant hearing aid 14 to 24 months after being fitted. They regard it to have significant advantages over their previous hearing aids. Four of the five patients use an ear level processor.

Two of the patients who had previously used conventional bone conduction hearing aids now use the ear level processor.

Considerable clinical success has been claimed for functional endoscopic sinus surgery but objective assessment of prospective series is lacking in the literature. Twenty-four patients with chronic rhino-sinusitis underwent assessment of symptoms by visual analogue scoring, nasomucociliary function by ciliary beat frequency, olfaction by qualitative olfactometry and nasal airway resistance by anterior rhinomanometry pre- and post-operatively. This demonstrated a significant improvement in all symptoms examined and in ciliary beat frequency. Quantitative olfaction and anterior rhinomanometry were not improved despite diminished symptoms. These results offer quantitative evidence of clinical improvement following functional endoscopic sinus surgery which supports the pathophysiological concepts on which the technique is based.

One hundred and thirty two patients who had undergone tonsillectomy for recurrent sore throats were evaluated by a questionnaire regarding the effectiveness of their operation. There were 98 respondents of whom 88.8 per cent were satisfied with the benefit gained. Smoking habit did not affect the post-operative satisfaction rate. Dissatisfied patients were more likely to have changed their General Practitioner recently and more likely to have had multiple hospital referrals in the past. Improved patient satisfaction rates may be achieved by more careful assessment of patients with the latter characteristics.

Acute epiglottitis in the adult is a rare disease, which has shown an appreciable increase since the sixties and in our locality since 1984. We present a review of the cases registered in our hospital, analyzing their aetiology, evolution and treatment. The disease is most likely to be suspected in the presence of any patient having a sudden dysphagia. especially if he shows symptoms of an acute infection and a lack of oropharyngeal pathology.

Management of otitis externa and the discharging mastoid cavity accounts for a significant proportion of the ENT out-patient workload. A simple technique of topical application of dermatological preparations is described which is easy and effective.

Perforation of the tympanic membrane is a frequent complication of surgery for exostoses of the external auditory canal We report an unusual histopathological finding in a temporal bone containing external canal exostoses which suggests that some of these perforations may be unavoidable.

Intractable epistaxis associated with septal perforation is a difficult problem to treat, particularly if nose-picking appears to be associated. Two such cases are presented in which Young's procedure of nasal closure was used to prevent epistaxis. Although the procedure was fully successful in only one patient. we feel the procedure has a part to play in the management of such cases of epistaxis.

Foreign bodies in the upper aerodigestive tract represent one of the commonest ENT emergencies. A case report of a fish bone penetrating the anterior tongue is presented which exemplifies this frequent problem. but at a rare site.

A cause of nasal obstruction in sickle cell anaemia not previously described in the literature is presented.

The pathophysiology is the same as in priapism because of the similarities in the vascular arrangement of the turbinate and the penis.

Various treatment options are considered but the best results were achieved by surgical reduction of the inferior turbinates.

The first case of low-grade papillary adenocarcinoma of the nasopharynx is described from an area where carcinoma in the nasopharynx is endemic. Clinicopathological features are detailed and differences between the prevalent nasopharyngeal cancer and low-grade nasopharyngeal papillary adenocarcinoma are emphasized. This tumour requires positive identification as surgical management is necessary to avoid the possibility of future recurrence.

An unusual skull base tumour is presented. Intraoperative smears made the diagnosis and dictated a change in surgical strategy. Giant-cell tumours of the sphenoid bone are discussed, together with current management.

Haemophilus influenzae is a common cause of epiglottitis and meningitis in children and exacerbation of chronic bronchitis in adults. However, the ability of this organism to cause serious infections in adults is less well recognized. We report a case of a 34-year-old previously healthy female who presented with epiglottitis and later developed bilateral empyema; both blood and pleural fluid grew Haemophilus influenzae.

Toxoplasmosis is a protozoan infection manifested by systemic findings as well as generalized or localized lymphadenopathy. Although lympadenitis is the most common clinical form, involvement of the intraglandular nodes within the parotid gland found is a rare occurrence during the course of the disease.

This unusual form may mimic a parotid mass, and can cause difficulties in differential diagnosis. In this article, a case of intraglandular parotid lymphadenitis which developed due to toxoplasmosis is presented, and the relevant literature is reviewed.

A case of giant lateral cervical cystic metastasis from occult thyroid carcinoma mimicking branchial cleft cyst is reported.

Lateral cervical cystic metastases arising from occult thyroid carcinoma and their ultrasonic differentiation from true cysts are discussed.