Computed tomography is replacing contrast radiography as the method of choice in evaluating congenital posterior choanal atresia. Careful preparation of the patient, however, is necessary prior to the examination in order to obtain the maximum of information pre-operatively.

We present patients with inadequate preparation and illustrate their misleading scans. The proper method of examination is discussed, with a review of the literature; it is essential to remove nasal secretions by suction and instil vasoconstrictor nose drops, shortly before scanning.

Our pilot study reports twenty-six cases of resolved chronic otitis media in which the human, cadaveric styloid process was used as an ossicular graft material. A maximum follow-up of one year is presented in this paper. There was no extrusion or rejection of the styloid processes. Hearing improvement with a closure of the air-bone gap to within 10–15 dB. of the pre-operative bone conduction was found in most cases. So far the styloid process has proved to be an ideal ossicular graft though the long-term results are yet to be seen.

In this paper, I shall mention a survey I undertook in September 1986 on the prevalence and aetiology of tracheostomy among children in the U.K. (Jennings, 1987). Four hundred and fifty-five members of the British Association of Otolaryngologists were circulated with a questionnaire and 58 per cent responded.

The use of pectoralis major flaps for reconstruction after oral and oropharyngeal resection in a series of seventeen patients is reported. The applications and complications are described. A post-operative assessment of speech, chewing and swallowing in ten of the patients is reported. The functional aspects of such surgery are discussed.

A retrospective review of 64 Goode ‘T’ tube insertions is presented. These were inserted into 61 ears of 48 patients over a period of four years. At the time of review of these 61 ears, 34 tubes were found to be in situ, 27 had extruded spontaneously and three had been removed surgically. Ten ears in which the tube had been extruded or removed had central perforations of the tympanic membrane of which eight had been present for more than six months. The number of previous myringotomies or grommet insertions did not increase the likelihood of developing a perforation. Tympanostomy tubes of this type should not be used indiscriminately.

The authors report on a series of 24 patients in whom open cavity mastoidectomy cavities were obliterated with bone pâté. The aim of the procedure is to provide the patients with a dry ear which then also reduces the need for frequent out-patient attendances.

A study was done on 41 patients to compare the use of the Walkman Mini-stereo system with different types of phones to mask tinnitus, by using music, or relaxation or different bands of noise similar to those generated by a tinnitus masker or pure tone, and it was found that the Walkman Mini-stereo system with any types of phone, was as effective, and more economic, both to patients and to the N.H.S., than traditional tinnitus maskers. It should be recommended for the management of tinnitus i n preference to the traditional tinnitus maskers.

The presence of upper respiratory tract obstruction in patients with acromegaly has been described. The main sites for obstruction were previously thought to be laryngeal and oropharyngeal. This reviews 65 patients with acromegaly and 27 patients with a prolactinoma treated by trans-ethmoidal hypophysectomy. The results confirmed a very high incidence of polyp formation and mucosal hypertrophy within both the sphenoid (88 per cent) and ethmoidal (62 per cent) sinuses of the acromegalic patients. The histological appearances of the mucosal hypertrophy and polyposis confirmed no specific features attributable to acromegaly. Patient age and serum H.G.H. level do not appear to be significance factors. These findings within the para-nasal sinuses have never previously been reported.

In each of twelve matched pairs of patients undergoing tonsillectomy one patient was vaccinated with Pneumovax®, a pneumococcal polysaccharide antigen, prior to tonsillectomy, the other patient being vaccinated after tonsillectomy. Sera were tested for antibody response to three different pneumococcal types of IgG, IgA andIgM classes. The patients with intact tonsils at vaccination did not develop higher antibody response than did those tonsillectomised prior to vaccination. On the contrary, in the case of pneumococcus type 6A, the IgM antibody response in tonsillectomised patients was significantly higher than that in patients with intact tonsils at vaccination (p = 0.021). Thus, the present study did not support the notion thattonsillectomy affects antibody response against pneumococcal vaccination. The palatine tonsils' role as an immunologically reactive organ is also discussed.

The major features of the Branchio-Oto-Renal syndrome (BOR syndrome), an autosomal dominant disorder, are branchial remnants, ear anomalies, deafness and renal dysplasia.

We report two family groups affected by the BOR syndrome: in two-thirds of the affected children renal abnormalities led to severe renal insufficiency in early life. The necessity for a meticulous search for renal anomalies in individuals with aural and/or branchial abnormalities is emphasized. In affected families, genetic counselling is suggested.

Apart from the neonatal period acquired subglottic stenosis is most often seen in infancy and early childhood. It remains the commonest indication for tracheostomy in the paediatric age group, (Jennings, 1987). The aetiology is usually multiple and may include major contributory factors from the airway itself, the presence of an intercurrent illness and the complications of intubation (Table I). The airway may be intrinsically normal or abnormal at birth but may subsequently be stressed by various events such as infection either in the neonatal period or in the first few months of life. Extrinsic compressions of the airway, for example by a vascular ring (Westaby et al., 1984) may produce tracheomalacia so increasing the risks of respiratory obstruction during intercurrent infection. Intubation is the preferred method of airway support for those with associated severe respiratory failure but brings with it a number of potential complications which may eventually lead to significant subglottic narrowing.

There is much controversial evidence that children gain weight to a significant extent following tonsillectomy, usually associated with a general improvement in health. One hundred and nine consecutive children undergoing tonsillectomy in Dundee for recurrent tonsillitis had their weights recorded pre-operatively, and twelve months after surgery were re-weighed and a symptom chart completed. The results showed the patients were generally not underweight before surgery as their median weight was on the 55th. percentile. Most parents reported an improvement in their child's appetite with a reduction in the number of sore throats after surgery. Their weights following surgery had increased by an average of 20 per cent over what would normally have been expected, but this increase in weight was not confined to underweight children, but to the entire group.