A preliminary report on a technique of myringoplasty is presented with the idea of minimizing graft rejection, and to combat anterior blunting and lateralization of the graft. The grafts were generally stable and mobile. Out of 200 cases there was only a 2 per cent rate of graft rejection, with no evidence of anterior blunting or lateralization. The hearing improved considerably. The technique is simple and relatively quick.

Mast cells in rats have been categorized into mucosal and connective tissue mast cells by properties which include their fixation characteristics and their distribution in tissues. There are a number of factors which make his classification unsatisfactory including the variability of fixation, intensity of background staining and the application of animal studies to man. Seasonal allergic reactions in the nose of man occur both in the surface metachromatic cells and in those within the epithelium; the latter are presumed to be mucosal mast cells. The aim of this study was to look at the distribution and the fixation characteristics of mast cells in inferior tubinates and nasal polyps. Both techniques show that cells are more abundant in the submucosa and the fact that Carnoy's fixative shows them better and this may be due to the lack of intensity in the background staining. There is no evidence that mast cells are more frequent in the epithelium. These findings would suggest the nasal polyps are not an allergic disease.

This study was undertaken to determine the incidence of unidagnosed apical disease in acute unilateral sinusitis and to evaluate the role of Orthopantomograms (OPGs).

Our results, with an incidence of 10 per cent, are in agreement with the findings of Formby (1960) and we conclude that OPGs are not justified in the routine investigation of acute sinusities.

The records of 120 patients who had undergone revision stapedectomy were analyzed to determine: (i) the causes of failure; (ii) how to prevent failure by taking precautions during primary surgery; (iii) hearing results; and (iv) possible identifying factors which might pinpoint those patients with a high risk of sensorineural deafness.

A review of these cases demonstrates that the results of revision stapedectomy are different from those of primary stapedectomy. The commonest cause of failure was prosthetic dislocation (30.8 per cent), followed by fibrous adhesions (18.3 per cent) and otosclerotic regrowth (14.1 per cent). First revision operations resulted in post-operative bone-air gaps of 15 dB. or less in 46.5 per cent of cases, much better than 25 per cent for second revisions. Primary stapedectomy resulted in successful closure of the air-bone gap to 15 dB. or less in 89.5 per cent of cases.

The sensorineural loss occurred in 11.3 per cent or first revisions and in 16.6 per cent of second revisions, as compared to 1.3 per cent after primary surgery. “Dead ears” were encountered in 2.2 per cent of first revisions, as compared to nil in the primary group.

Closure of the nostril in atrophic rhinitis is a simple operation. Opening the obturated nose by excising the obturator membrane very often causes stenosis. A new and effective method for opening the nostrils, by meant of flaps, is suggested.

To determine which factors were associated recurrence of ottitis media with effusion following grommet insertion, the casenotes of 323 who had a total of 485 operations for grommet insertion were reviewed. The incidence of repeat surgery was higher in those aged between four and six years, in those having grommet insertion between the months of July and October and in those cases in which the grommet was extruded within six months. Recurrence was not related to sex of patient, month of listing for surgery, adenoidectomy, tonsillectomy, length of time on the waiting list or past history of previous grommet insertion.

Direct access to the whole length of the cochlear turns via endaural middle ear approach for the placement of extracochlear electrodes is severely restricted. Approximately 10 mm. of the cochlear turns are accessible, being less than a third of their length. The middle cranial fossa, the facial nerve, the internal carotid artery and the temporomandibular joint restrict the access. A further restriction is caused by the position of the cochlea and the direction of its axis. The anterior part of the cochlea lies anterior to the tympanic membrane and medial to the temporomandibular joint, thus limiting an endaural approach to a posterolateral direction. Despite this limitation small sections of the basal, middle and apical turns of the cochlea can be reached.

A study was conducted on seventy children to ascertain any relationship between parental smoking and the presence of middle ear effusions in the children.

Information was collected using a questionnaire, clinical examination and audiological tests. Both groups of children (with and without effusions) has similar age, sex and social class distributions.

It was found that the presence of middle ear effusions in the children was associated with an increased incidence of parental smoking. Those children with an abnormal tympanometry result were more likely to have at least one parent who smoked than those with normal tympanometry results. There was no relationship between resolution of the effusion and parental smoking.

It is therefore suggested that as part of the management of this condition parents should be advised of the effects of smoking on the condition and encouraged to avoid smoking in the same environment as their children.

Many antibiotics, chemotherapeutic agents and other chemicals have been tried in the treatment of scleroma without much success (Toppozada et al, 1967). The most popular of these drugs are streptomycin and aureomycin (Botros et al, 1954; Zwiefach, 1955; El-Mofty, 1962), terramycin and chloromycetin (Hoover and King, 1953) and ampicillin, septrin and vibramycin (Ssali, 1975).

El-Mofty and Attia (1957) attributed considerable value to the use of 20 per cent aureomycin ointment locally in treating the disease. Nigonol in the form of a local injection was tried by Toppozada et al. (1967) and they claimed good results. Shaer et al. (1981) reported that local application of 2 per cent acriflavine solution over an eight-week period was an effective and safe remedy for rhinoscleroma.

Rifampicin has been used systemically with success as a new antibiotic for the treatment of scleroma (Riad, 1982). The aim of the present study was to evaluate the response of rhinoscleroma to local medication with rifampicin.selected for this study. The cases were diagnosed by clinical, histopathological (Fig. 1) and bacteriological data. Twelve cases were in the atrophic stage while eighteen were in the granulomatous stage of the disease. Rifampicin was applied locally into the nose in two forms:

1. Nasal instillations: used mainly in the atrophic cases. One ampoule of rifampicin (Rifocin-Lepetit®) 125 mg. diluted in 20 ml. saline solution was used and 2 ml. of the solution was applied twice daily.

2. Nasal infiltration: used mainly in the granulomatous cases. One ampoule of rifampicin (Rifocin-Lepetit®) 125 mg. was infiltrated into the granulomas every other day.

Treatment was continued for eight weeks. Punch bio-spies were taken from the nasal lesions after four and eight weeks during the course of therapy and six months after the cessation of treatment. Biopsies were fixed, dehydrated, embedded in paraffin, sectioned and stained with H and E. Part of each specimen was submitted to bacteriological studies for the isolation of K. rhi-noscleromatis (Levine, 1951).

To date only few and often disagreeing studies about human nasopharynx are available.

The present research has the purpose to give a contribution to the knowledge of nasopharyngeal epithelium using S.E.M The study was carried out on biopsies taken from 20 healthy volunteers.

The surface of nasopharynx is covered by ciliated cells, microvilli provided cells and goblet cells.

Areas covered with squamous epithelium and presumably transitional epithelium were observed.

The possibility that ciliated become microvilli provided cells is discussed.

The incidence of both lateral and cavernous sinus thrombophlebitis has been significantly reduced in the antibiotic era. Since septic cavernous sinus thrombosis (CST) is mainly a complication of facial abscesses and septic lateral sinus thrombosis (LST) is almost invariably due to chronic otitis media, both conditions are of clinical relevance to the otolaryngologist.

The predominant bacterium in septic CST is Staphylococcus aureus whereas in septic LST the bacteriology is very similar to that found in chronic otitis media. The diagnosis of septic CST can be established in most cases after thorough clinical examination, and contrast computerized tomography (CT) using the coronal projection usually confirms the clinical diagnosis. The signs and clinical course of septic LST are non-specific and the final diagnosis rests upon radiological investigations including CT-scan. The treatment of both conditions consists of broad-spectrum antibiotics, including beta-lactamase resistant penicillin in cases of septic CST. Most cases of septic LST also require surgical intervention.

Two cases oi septic intracranial sinus tiuombosis ate presented. The need for early diagnosis and treatment of this potentially lethal condition is emphasized.

Objective and subjective measurements of nasal airflow were made before and after inhalation of Vanilla, D-Menthol and L-Menthol separately. Despite the fact that the menthol isomers were mirror images of one another, only L-Menthol produced the sensation of increased nasal airway patency. No objective change in resistance was found after inhaling either D-Menthol, L-Menthol or the vanilla control. These findings demonstrate that L-Menthol exerts a specific action upon nasal sensory nerve endings, which are responsible for the subjective appreciation of nasal airflow.

Thirty-six patients with bilateral symmetrical presbyacusis who reported a temporary improvement in the hearing of one ear following a Valsalva's manoeuvre were further investigated. Bone conduction and air conduction thresholds, middle ear pressure and middle ear compliance were measured before and after Valsalva's manoeuvre in the ears which had a subjective improvement in hearing following auto-inflation. Bone conduction thresholds remained unaltered in 66 per cent of ears while average air conduction thresholds varied by less than 5 decibels. Middle ear pressure was unchanged in over half the ears tested and in 81 per cent of the ears there was no change in middle ear compliance. There appears to be no simple explanation for the temporary subjective fluctuation in hearing reported by patients with presbyacusis.

This can conveniently be divided into two parts. First, anaesthesia for diagnostic endoscopy and further assessment of subglottic stenosis and, second, anaesthesia for laryngeal reconstructive surgery.

The value of Politzerization as a method of treatment in atelectatic ears and secretory otitis media is controversial. In some places it has been used routinely for decades, in others it has been almost forgotten. A quantitative study of its therapeutic value has been difficult to find.

The present study is an attempt to evaluate the therapeutic value of such an ‘air douche’ in atelectatic ears. Thirteen middle ears with atelectasis were Politzerized daily with air or N2 for up to five consecutive days. Once Politzerized, the atelectasis and retraction pockets disappeared in all the ears examined. However, continuous observation of the Politzerized ears with the surgical microscope revealed that all the ear drums returned swiftly to their retracted position. The time it took for a drum to return to its original place varied from 15 minutes up to a maximum of 335 minutes. Our observations show that even an increased number of Politzerizations did not alter the speed of reappearance of the atelectasis. It would therefore seem that the therapeutic value of Politzerization in atelectatic ears is doubtful.

The site of origin of maxillary sinus carcinoma will not infrequently predetermine the varied neurological signs at presentation. Modifying Ohngren's division, the maxillary sinus can be divided into for quadrants based on anantomical nerve correlates, thus facilitating identification of the primary site. An inclusive classification of maxillary sinus caricinoma based on Broder's grading, site of origin, the TNM classification and the patient's general condition, serves as the basic for a correlative therapeutic regimen.