A group of 33 patients with the autosomal dominant form of Waardenburg Type II syndrome underwent hearing and vestibular examination. A bilateral, symmetrical, sensorineural hearing loss was found in 51 per cent of the tested subjects. The severity of hearing loss varied from mild to severe. Strong evidence indicated the possible progressive nature of the hearing loss. Concerning the frequency of vestibular findings, the study highlights the frequent divergence between cochlear and vestibular involvement.

In this prospective study of 126 patients attending the ENT outpatient clinic the doctor's and the patient's perception of the consultation were evaluated by questionnaire; 96 patients completed the questionnaire correctly. The results were analysed by scattergram plot and Wilcoxon's matched-pair signed ranks test. There was a statistically significant difference between the doctor's and the patient's perception of the ‘history’ (p<0.01) and the ‘explanation of diagnosis and treatment’ (p<0.05) in the consultation. There was no statistically significant difference between the doctor's and the patient's perception of the ‘examination’ in the consultation. The results are discussed.

The past history of, and current trend in, stapes surgery are reviewed, and experience from a personal series of 128 procedures over an 18 year period is presented. Results are frequently poorer than many surgeons and their patients anticipate, and more stringent pre-operative case selection and centralisation of surgical activity would appear desirable. Amplification has become a more acceptable management alternative for some patient categories.

Viable and non-viable B. catarrhalis were mixed together with S. pneumoniae and H. influenzae and injected into non-bacterial mucoid effusion material collected from the middle ear of patients with a present secretory otitis media. The samples were incubated at 37°C. Presence of viable B. catarrhalis could evidently prolong the survival of both S. pneumoniae and H. influenzae. Presence of non-viable B. catarrhalis could also enhance the growth of S. pneumoniae, but not H. influenzae. In contrast both S. pneumoniae and H. influenzae suppressed the growth of B. catarrhalis.

To obtain the best possible results of treatment of acquired cholesteatoma, we made a subdivision of cholesteatoma types into attic and pars tensa cholesteatomas, and subdivided the latter further into tensa retraction cholesteatoma and sinus cholesteatomas. Tensa retraction cholesteatoma is defined as arising from a retraction or perforation of the whole pars tensa, whereas sinus cholesteatoma is defined as arising from a retraction or perforation of the postero-superior part of the tensa. We present the long-term results obtained in tensa retraction cholesteatomas treated with one stage surgery from 1964 to 1980. Median observation time was 9 years, range 2 to 19 years. Sixty-one ears were treated without mastoidectomy, whereas 71 ears had canal wall-up mastoidectomy and 64 ears had canal wall-down mastoidectomy. The total recurrence rate was 13.3 per cent; 17 ears had residual cholesteatoma, and nine ears had recurrent cholesteatoma. The best results were obtained in ears with an intact ossicular chain where mastoidectomy was not performed. In 49 per cent of the cases, the cholesteatoma was confined to the tympanic cavity without reaching the aditus, antrum or mastoid process. About one-third to one-quarter of the ears had tympanoplasty only, with removal of the cholesteatoma through the ear canal.

Angiofibromas of the post nasal space have the potential to extend in all directions along predetermined pathways with a definite mode and chronological pattern. In order to understand their clinical behaviour, methods of treatment and prognosis, a system of clinical staging based on conventional and tomographic observations has been found useful in this series of cases. The classification has been evolved according to the extent of the tumour involvement but also the age of onset, duration, size and area of encroachement including the surgical approach and consequent prognosis. Deficiencies in the earlier classifications are discussed.

A sublabial incision with septal transfixion and mid-face degloving is described as an approach to the nasal cavity, paranasal sinuses and nasopharynx. A brief history of the development of the technique is given. The results of nine cases are presented. These cases have had good tumour clearance, excellent cosmetic results and the minimum of complications. The sublabial approach is most useful in children and women, particularly those with intermediate grade tumours. The advantages of the approach compared to the lateral rhinotomy incision include: superior access to the floor of the nose, inferior turbinate and anterior nasal septum; access to both sides of the nasal septum and the absence of a facial scar. The limitations of the sublabial technique are the poor access to frontal sinus and the cribriform plate.

Otitis media with effusion was the presenting symptom in 23 per cent of patients suffering from chronic sinusitis. The inter-relationship between chronic sinusitis and otitis media with effusion was studied in 29 patients. Endoscopic evaluation of intranasal structures including sinus ostia and Eustachian tube orifices was carried out. We further suggest that otitis with media with effusion is not a separate entity but a presentation of sinus disease, predominantly of the ethmoid system. Patients with otitis media with effusion should be evaluated for sinusitis and vice versa. The value of careful nasendoscopy is demonstrated.

A new material, the wax paper enveloping the Fucidin® gauze which is routinely used to pack the nose post-operatively, was utilized in 120 cases considered as ‘high-risk’ for the formation of post-operative nasal adhesions. This proved to be an inexpensive, simple and effective method when the prevention of the formation of nasal adhesions was the primary goal.

Through an ultrastructural study of the endolymphatic duct (ED) and sac (ES) system, the effects of an impaired body fluid metabolism on the inner ear fluid environment in the mongolian gerbil has been evaluated. A dehydrative state has been determined depriving of water for both five and twelve days this desert animal, which is known to withstand long periods of water abstinence. The morphological changes of the ED and ES under these circumstances have been compared with those induced by ethacrynic acid intoxication. Although the cochlear partition did not show signs of damage, the ED and ES system seems to be negatively influenced by the dehydrative state and displays a marked imbibition of the subepithelial tissue, which at places shows accumulation of an organic matrix.

A regulating role for the antidiuretic hormone on the inner ear fluids of the mongolian gerbil is also proposed and discussed.

The number of operations for cholesteatoma, together with the number of cases undergoing insertion of ventilation tubes in the Tayside region of Scotland between 1966 and 1986 have been studied. During this period there has been a sixty fold increase in the use of ventilation tubes, but the incidence of cholesteatoma surgery has only varied between 0.94 and 1.88 operations per 10000 of population per year. The mean annual incidence of cholesteatoma during this period was 1.32 cases per 10 000 of population. The results indicate that there has been neither a rise nor a fall in the incidence of cholesteatoma in Tayside despite a considerable increase in the use of ventilation tubes.

Continuous drooling after infancy is rarely seen in normal children. Neurologically damaged children are more likely to continue to drool, and it may be so severe in some cases as to require surgical correction. Submandibular duct relocation is a procedure with minimal morbidity and excellent results. This procedure has been carried out on 16 children at the Eye and Ear Hospital and Temple Street Children'hospital, Dublin, between the years 1982 to 1987. An overall improvement occurred in 13 cases with only one post-operative complication. Such surgery has transformed the lives of these children as well as being a great source of relief for the parents.

Unilateral vestibular nerve section (VNS) creates a state of acute dysequlibrium which resolves by a process of central compensation. This disturbance resolves quickly and central compensation is complete generally within a month with resolution of symptoms and signs. The course of central compensation following VNS will be similar to that seen after labyrinthectomy because the detachment of hemi-labyrinthine input that is achieved by both will be identical. Six patients are presented who have undergone VNS at least 2.7 years ago (Average 3.5 years); all of them have persisting spontaneous peripheral type horizontal jerk nystagmus, present with optic fixation in five. This is obvious clinically and was confirmed in each case by agreement of three independent observers and has been recorded by electronystagmography (ENG). They are free from marked vestibular symptoms. The explanations of mechanisms involved in central compensation are discussed with respect to this previously unrecorded clinical observation.

Nasal implants of autologous costal cartilage have an undesirable tendency to distortion. This tendency may be reduced by the process of devitalization, which occurs in the preparation of homologous costal cartilage for storage in a tissue bank. An in vitro study has been undertaken, utilizing five common methods of cartilage preparation (cialit, ethyl alcohol, formalin, glutaraldehyde and irradiation) to determine whether there is any significant variation in the degree of distortion which occurred and any variation in cartilage consistency. We conclude that all of the methods evaluated would produce banked homologous costal cartilage with an equally low incidence of distortion but implants are less readily carved from cartilage stored in cialit.

A statistical study was done on the sensorineural component in hearing loss, using 595 patients suffering from Chronic Otitis Media (COM); of these, 195 with monolateral COM were taken into consideration. They presented criteria of valuation which excluded other possible causes of sensorineural hearing loss, such as exposure to acoustic trauma, ototoxic drugs, cardiovascular disease, past head injury and hereditary causes. The contralateral (healthy) ear served as a control. We determined the average sensorineural component in the hearing losses in relation to the age of onset and duration of the disease, examining it in relation to other eventual aural complications such as cholesteatoma.

On the basis of the data obtained, we believe that the sensorineural component in hearing loss does not change with respect to the age of onset of COM, but the duration of COM does exert a significant influence.

Recurrent meningitis in children is not only a potentially life threatening condition, but often involves the child in the trauma of repeated hospital admissions and multiple and invasive investigations to try and find an underlying cause. Symptoms and signs of CSF rhinorrhoea or otorrhoea are infrequent in these patients. Unilateral deafness may be difficult to diagnose in the young child. Full ENT examination may be normal.

We report seven cases of children with recurrent meningitis in whom inner ear abnormalities were only indicated as the site of entry of infection by hypocycloidal tomography or high resolution CT scanning of the temporal bone. Subsequent tympanotomy confirmed the site of the CSF leak as the oval window in the majority of cases; packing the vestibule with muscle halted further attacks in these patients.

The degree of inter-observer variability in the results of pneumatic otoscopy, used to predict the presence or absence of middle ear effusion was assessed. A group of 114 patients with 209 suitable ears had pneumatic otoscopy using a Seigle's speculum performed independently by two observers. The results were compared to the findings at myringotomy, on the basis that mobility of the tympanic membrane was indicative of a dry middle ear. The observers agreed in 187 ears, a concordance rate of 91 per cent, and in 174 of these (93 per cent) the observers' prediction of middle ear state was correct. The overall predictive accuracy of observer A was 89 per cent and of observer B 84 per cent, this difference is not statistically significant, p> 0.05.

Reports concerning the lesions of the skin coverage of the external ear canal in malignant external otitis (M.E.O.) are very few. To evaluate this problem, we studied the skin lesions of 45 skin biopsies from 40 M.E.O. patients, 23 from regions covering the osseous part of the ear structure, seven from the cartilaginous part of the external canal and 15 from both parts. The epidermis was normal in nine, thickened in 16, with acanthotic thickening and pseudoepitheliomatous hyperplasia in 20. In the dermis the amount of collagen was normal, but it was infiltrated by the inflammatory process. Acute inflammation was observed in 16 biopsies, subacute in 23, chronic in six. A mixture of acute and chronic changes was present in 18 biopsies. No major abnormalities of the vasculature could be detected. The distinguishing pathological feature of M.E.O. concerns the typical topographic distribution of the inflammation in the osseous part of the external ear canal.

Practice in the Temporal Bone laboratory is a fundamental part of Otological training. Performing a stapedectomy on a normal temporal bone is handicapped by the mobility of the footplate. We describe a simple method of producing stapes footplate fixation in a normal temporal bone so that the operative conditions found in otosclerosis are more closely simulated.

Patients with carcinoma of the tongue including the base of the tongue who underwent total glossectomy in a period of just over ten years since January 1979 have been reviewed. Total glossectomy may be indicated as salvage surgery or as a primary procedure. The larynx may be preserved or may have to be sacrificed depending upon the site of the lesion. When the larynx is preserved the use of laryngeal suspension facilitates early rehabilitation and preserves the quality of life to a large extent. Cricopharyngeal myotomy seems unnecessary.