A study was undertaken to detect undiagnosed deafness in elderly people, living in Part III Residential Homes in North Tees, South Tees and Hartlepool Health Districts, to provide hearing aids and to estimate the subsequent success in rehabilitation. The residents were referred by the senior staff in the homes and assessed by a doctor and audiology technician in a domiciliary setting. Those found to have a significant hearing impairment were prescribed hearing aids without formal pure tone audiometry. A pilot study compared the method of hearing evaluation employed with such conventional testing.

Six months after fitting, the degree of compliance with aiding was assessed. The results show a significant level of undiagnosed deafness in the community and, with this method of provision, an acceptance rate of 41.2 per cent of those recommended for aiding at six months which is higher than suggested by previous similar studies of this population.

The otoadmittence or impedance measurements are common procedures in the diagnosis of middle ear pathologies. The present study was undertaken for the purpose of studying the clinical validity of static admittance values in 42 confirmed otosclerotic ears. For both 220 Hz and 660 Hz probe tones only one third of the otosclerotic ears had low admittance values, as expected. The remainder showed admittance values in the normal or high ranges. No significant correlation was found between air bone gap (ABG) and the admittance values.

Questionnaires have been sent to all ENT Consultants practising in the UK in an attempt to establish current practice with regard to out-patient examination of the upper aerodigestive tract. Seventy-eight per cent of these were returned completed. The results indicate that mirror examination remains the most widely used method, though the fibreoptic rhinolaryngoscope and/or the Hopkins rod telescope are now used by many specialists. Mirrors are most frequently warmed by a spirit lamp, despite the fact that 125 respondents reported having had a fire in their departments. Other methods of warming mirrors are discussed.

A retrospective analysis of 76 patients who underwent acoustic neuroma removal is reported. Facial nerve function prior to surgery and tumour size are assessed with respect to final facial nerver recovery and the need for surgical rehabilitation. Both pre-operative facial weakness and tumour size greater than 2.5 cm. are shown to be predictive factors of poor facial nerve recovery. Multiple surgical rehabilitative procedures are often required when inadequate function and/or cosmetic results are obtained. Primary nerve repair and facial-hypoglossal anastomosis give better rehabilitative results than dynamic and static procedures. The association of tumour size greater than 2.5 cm. with increased risk of poor facial recovery re-emphasizes the need to detect and remove acoustic neuromas at an early stage.

A prospective study on 210 patients was conducted to determine the relative efficacy of infiltration anaesthesia as against surface anaesthesia for antral lavage. The patients were categorized into three groups and comparisons were made on patient response and our observations. This study confirms that infiltration technique is superior to surface anaesthesia and is, also, less time consuming.

Nasal myiasis is a manifestation of the nasal cavities by larvae of the fly of genus Chrysomia. It is prevalent in tropical countries. Atrophic rhinitis is the most commonest predisposing factor for this condition. The maggots can cause extensive erosion of the nose, face and intra-cranial structures occasionally causing meningitis and death. Conservative management by packing the nose with a chloroform and turpentine (1:4) mixture followed by manual removal of the dead maggots is an effective method. Recurrence is known but partial closure of both nostrils to improve the condition of nasal mucosa is the important part of management.

Treatment of the paralyzed face remains a challenging surgical problem. When facial nerve damage is irreparable or facial nerve grafting has failed, static and dynamic techniques must be considered. A two-staged modification of the dynamic muscle transfer using ipsilateral temporalis muscle is described. Initially, a free temporalis fascia graft, harvested from the contralateral scalp, is placed around the oral commissure of the paralyzed side of the face through an incision in the nasolabial crease. Several weeks later, an ipsilateral temporalis muscle and fascia transfer is made to the anterior face and attached to the previously placed fascia graft. Oral commissure grafting, as a first step, provides for a secure anchoring point for the temporalis flap, and achieves a more satisfactory correction of the oral commissure.

There is scant literature relating to tinnitus in children. This may be due in part to the inability of the child to differentiate normal from abnormal, and also adults failing to communicate adequately with children to allow them to describe their observed symptoms.

One hundred and two children with severe to profound hearing loss between six to seventeen years of age were questioned as to the presence of tinnitus. The 24 children (23 per cent) who reported tinnitus, also completed a questionnaire, and were interviewed about their symptoms and then were compared to the non-tinnitus children regarding hearing level, age, sex and aetiology of the deafness.

No significant difference was found between the two groups. This study documents that tinnitus does exist in a significant number of children with severe to profound deafness and addresses the problem involved in its description and assessment.

A series of 394 radical neck dissections performed over the 17 year period 1969–1986 is presented. The shortest period of follow-up is two years. Of the major complications reviewed, wound breakdown was associated with T stage, prior radiotherapy and incision used but not with age or N stage. Cervical recurrence was associated with N stage, prior radiotherapy and surgical incision and inversely associated with age. Wound breakdown and recurrence were lowest in parotid primary tumours. Carotid artery rupture occurred in 17 patients (4.3 per cent), was fatal in all cases and was strongly associated with wound breakdown and previous radiotheraphy. The importance of the choice of incision, clearance of the posterior belly of the digastric muscle and carotied artery protection are discussed.

Sixty patients investigated for a suspected acoustic neuroma were questioned on the side effects of CT air meatography, a minimum of three months following the procedure. Twelve per cent of patients found the procedure itself so painful that a repeat examination would only be contemplated under general anaesthesia. Only 20 per cent of patients were asymptomatic after the procedure while 28 per cent of patients required bed rest for 24 hours or more (average 4.4±2.8 days). Sixty-two per cent of patients took three days or longer to return to normal health.

The duration and frequency of side effects is greater than previously reported, and emphasizes the need for full investigation of these patients prior to CT air meatography.

The availability of the low intensity CO2 laser beam, and the possibility of defocalization that is associated with control of subglottic high frequency jet ventilation, requires a more interventionist attitude regarding dyspnoea caused by a subglottic haemangioma in the infant. It is indeed possible reliably to reduce the size of the subglottic haemangioma, and thus to avoid a lengthy period of intensive care, as well as the problems of prolonged intubation or tracheostomy for drainage, while also avoiding long term steroid therapy. This approach in no way affects the spontaneous evolution of subglottic haemangioma in the infant; there is a tendency for the haemangioma to regress after the age of one year. The treatment does, however, permit a considerable improvement in the comfort of the infant's life during this difficult period between 3 and 12 months.

We illustrate this new attitude by presenting a report on four cases.

Fifteen dry, small or medium-sized tympanic membrane perforations were treated by local application of 1 per cent hyaluronic acid after excision of the perforation rim. The duration of the perforations ranged from two months to ten years. Fourteen of the perforations were covered within 15±7.4 (S. D.) days and 5 ± 2.4 (S.D.) applications were needed to achieve closure. Hyaluronic acid treatment of dry tympanic membrane perforations not exceeding one quadrant seems to be an alternative to surgical myringoplasty.

Frontal sinus surgery for chronic disease presents a variety of problems, in particular that of drainage. No matter how successful the surgical technique is in clearing disease from the sinus, it is still important that the fronto-nasal duct is kept patent unless the procedure is an obliterative one. Usually a tube is inserted for drainage and has to be kept in place for several weeks or months. This paper presents a study of 16 patients, suffering from frontal sinus disease, in whom a short-term drainage technique using a Foley catheter was employed between 1979 and 1988 at Lagos University Teaching Hospital, Nigeria. This type of drainage allows effective anchorage and irrigation with a decongestant. It has been found to give satisfactory results after 14 days in place and has had no unusual complications. It is therefore recommended for use in such cases.

The role of the anterior ethmoids in the pathogenesis of chronic maxillary sinusitis is still a subject of controversy. Although the symptoms of maxillary sinusitis may be clinically dominant, many previous studies have showed that the origin of this disease was, in most cases, located within the anterior ethmoid region.

This study included 100 Egyptian patients, suffering from chronic maxillary sinusitis (confirmed by maxillary sinoscopy), who were subjected to ‘systematic nasal endoscopy’. It was found that all cases of chronic maxillary sinusitis were associated with anatomical variations and/or pathological abnormalities of ‘the ostiomeatal area’. It is recommended, therefore, that during the diagnosis and treatment of chronic maxillary sinusitis, attention should be given to the region of the middle meatus and anterior ethmoid complex (or ‘ostiomeatal area’) for any anatomical variations and/or pathological abnormalities in order to avoid recurrence of maxillary sinusitis. This is the basis of the procedure of functional endoscopic sinus surgery.

Acoustic neuromas may be resected either by a suboccipital craniectomy or translabyrinthine approach; the latter gives good access without unduly traumatising the brainstem, but can lead to a higher incidence of cerebrospinal fluid (CSF) leaks. The surgical management of these leaks can be difficult; we describe a transmastoid extracranial technique using pedicled sternomastoid muscle that has produced complete resolution of the leak in all cases managed in this way.

In a series of 100 patients with unilateral acoustic neuroma the incidence of mastoid aching was found to be 25 per cent, though none of the patients reported this as their principal symptom. Mastoid ache was not related to tumour size, hydrocephalus, or duration of symptoms. However, there was a significantly higher incidence of facial numbness and diminished facial sensation, but not facial weakness, compared with the whole series. Since motor fibres are more resistant to pressure than sensory fibres, mastoid ache may signify the pressure of an expanding cerebellopontine angle tumour.

A modification of existing techniques for the treatment of auricular haematoma is described. This method employs incision, drainage and the application of silicone rubber splints (SilasticR). Existing methods of treatment are reviewed and discussed. A retrospective review of 16 cases using this technique showed a satisfactory cosmetic result in all cases.

Scleroma is an endemic disease in Egypt, which frequently results in subglottic laryngeal stenosis. Six patients suffering from laryngoscleroma are represented. They all underwent laryngotracheal resection of the stenosed segment, followed by direct anastomosis. The results were satisfactory in four of the patients. Surgery was abandoned in one patient who was believed to suffer from perichondritis following previous surgery. Restenosis occurred in a 14-year-old girl two weeks after surgery. This was attributed to recurrence, possibly due to residual activity of the disease which was missed before surgery.

Puncture and lavage of the maxillary sinuses is a common procedure in ENT practice. Repeated irrigations are required in chronic sinusitis refractory to treatment. In our department we use a No. 14 gauge Braunula® for such cases. Over 100 patients have been treated over the past two years with no significant complications. This device is inexpensive, sterile, safe and easy to use and we recommend its use for patients with chronic maxillary sinusitis requiring repeated irrigations.