The distribution of glycoconjugates in the 11 to 16 weeks old human fetal endolymphatic sac (ES) was analyzed using six biotinylated lectins; Wheat germ agglutinin (WGA), Abrusprecatorius agglutinin (APA), Ulexeuropaeus agglutinin I (UEA-I), Ricinus communis agglutinin 120 (RCA120), Helixpomatia agglutinin (HPA), Concanavalin A (ConA). In the 11 week old human fetus, fluorescent reactions with WGA, APA, RCA120 and ConA were detected in the ES. There was almost no reaction with HPA and UEA-I. In the 14 week old human fetus, however.fluorescent reactions with HPA and UEA-I appeared. This result suggests that the presence of glycoconjugates changes during the maturation process of the ES. Glycoconjugates detected with HPA were related to the epithelial cell elements of the ES epithelium. The reaction with UEA-I suggests that the stainable substance present in the ES lumen may be secreted locally by the ES itself.

Since good ventilation of the middle ear is a pre-requisite for successful myringoplasty, it was our policy to investigate the tubal function in dry central perforation of the eardrum and to correlate the manometric and endoscopic findings. Nasal endoscopy proved to be indispensable in diagnosing mechanical tubal obstruction and in localizing and even treating ‘hidden’ lesions in key areas, with probable normalization of the tubal function. The correction of the mechanical tubal obstruction must precede ear surgery. Whenever tubal obstruction is diagnosed as functional or idiopathic, the ventilation of the middle ear should be guaranteed during ear surgery by addition of a tympanostomy tube to the graft or drum remnant, and a guarded prognosis given.

This article presents the results of an analysis of the variable and surgically important relationship between the oval window, the fossular walls and the related posterior tympanic recesses in 50 temporal bones. The visual impressions of superficial and deep oval windows seem to correspond fairly closely to the depth of the inferior wall of the fossula fenestra vestibuli (FFV). The depth of the superior and anterior walls of the FFV by themselves, did not appear to have such a dominating relationship in determining the deep oval window. There does not appear to be a well defined posterior wall in the vast majority of the specimens (86 percent). In the event of scar tissue forming between the superior, inferior and anterior walls, the gap between the postero-superior part of the promontory and the posterior tympanic wall (posterior communication) could allow aeration of the region of the deep oval window in such an instance. Closure of this gap by a solid shelf of ponticulus or scar tissue could cause a localized malaeration of the fossula in most cases of deep oval windows. This is an entirely new concept of the likely problems of malaeration of a deep oval window which could arise due to anatomical variations and of the possible safety valve mechanism which could prevent such malaeration and its consequences.

The use of bone grafts for total ossicular chain reconstructions in patients with deep oval windows may result in varying degrees of absorption of the segment of the bone graft in the fossula fenestra vestibuli. The mechanism of bone absorption is described—a condition not described before.

Promontory stimulation testing was carried out on a series of ten patients who had undergone osseous labyrinthectomy. The thresholds, discomfort levels and dynamic ranges were found to be comparable with a series of ten patients who have subsequently been successfully implanted with the Nucleus 22 channel cochlear implant. These findings suggest that cochlear implantation might be possible in a labyrinthectomized ear.

The results of intraoperative monitoring of the electrocochleogram in patients undergoing surgery for poorly controlled Menières Disease are presented with particular reference to the masking effect of drill-generated noise. The results obtained using a direct, in vivo, electrophysiological method of assessment of drill-generated noise levels are compared with previous postmortem and intraoperative studies and the implications with respect to the likelihood of drill-generated noise induced acoustic trauma are discussed.

The number of mast cells in the inferior turbinate from patients with perennial allergy due to house dust mite were compared with ten normal controls. Ten random high powered fields were counted in the epithelium and the submucosa in samples which had been divided into two and fixed either in aqueous formaim or Carnoy's fixative. The sections from each block were stained with either Azure A or Chloroacetate esterase technique. No statistical differences were found. The lack of increase in mast cell numbers was attributed to degranulation since numbers have been shown to be increased in perennial allergy when sections are examined ultrastructurally.

Cytomegalovirus (CMV) is a common opportunistic infection in both iatrogenic and HIV-induced immunosuppression. The usual sites of involvement are the gastro-intestinal tract, retina and lung. We present three cases of CMV ulceration of the oropharynx. All three patients presented with symptoms localized to the oropharynx and in each case the diagnosis was only made on histological examination of ulcer biopsy specimens. The patients all responded well to ganciclovir treatment and at writing none have required maintenance therapy (7–11 months post diagnosis).

A prospective, randomized clinical trial was conducted on 60 patients with confirmed peritonsillar abscess to: (1) compare the safety and efficacy of permucosal needle aspiration with that of incision and drainage; (2) assess whether admission to hospital and treatment with intravenous antibiotics is necessary; (3) culture the pus obtained, in order to decide on a rational antibiotic regime.

Of the 60 patients, 30 were randomized to the needle aspiration group, and 30 to the incision and drainage group. The initial success rate was 87 per cent (26 of 30 patients) with needle aspiration, and 90 per cent (27 of 30 patients) with incision and drainage. Two patients required hospital admission, for rehydration and intravenous antibiotics. The commonest organisms cultured were streptococci (62 per cent); 97 per cent of all patients responded to penicillin. This study indicates that most patients with peritonsillar abscess may successfully and safely be treated by permucosal needle aspiration, and oral penicillin, on an outpatient basis.

Successful intubation can be accomplished in the majority of patients via direct laryngoscopy. However, situations frequently arise in which simple orotracheal intubation is contraindicated or impossible. In these situations retrograde tracheal intubation may be of particular use. This technique has been performed by novice physicians in cadavers, without difficulty or major complications. It has proved to be a quick, efficient and simple method to establish an endotracheal airway and should be a valuable adjunct for airway control.

Certain problems have been encountered using a rigid endoscopic technique for tracheo-oesophageal puncture in voice restoration following laryngectomy. An alternative method is described using a modified curved abdominal forceps which allows quicker and more predictable access to the puncture site.

Tracheo-oesophageal puncture now has a well established role and in several units is now the principal means of speech rehabilitation following laryngectomy. Although not a difficult procedure, there are a number of problems and complications that may be encountered. With proper management these can usually be overcome and a useful voice achieved.

This study looks at those problems in a series of 119 patients and discusses their management.

In this series of seven uncommon and complicated cases of foreign bodies in the aerodigestive tract of children, the difficulties in the management, and complications encountered are described. Various factors affecting the outcome of these cases have been highlighted.

Forty-six patients who had undergone a radical neck dissection more than six months previously were assessed to determine the degree of handicap that results from division of the accessory nerve. Employment problems, amount of pain, and social and recreational difficulties were assessed. Forty-six per cent of those in employment prior to their operation gave up their work specifically because of problems with their shoulder; this affected more manual than non-manual workers (11 out of 20 manual compared with zero out of four non-manual). Thirty per cent complained of moderately severe or severe pain related to the shoulder. The amount of pain could not be correlated with age, sex, side of operation in relation to handedness, physical build of the patient, or whether the patient had been treated with radiotherapy. Although this is the largest study to address this question since that of Ewing and Martin in 1952, the small numbers involved mean that if any such correlation exists then it may not have become apparent. In view of this incidence of pain and occupational handicap, we feel that efforts should be made to preserve accessory nerve function in cases where surgical clearance of the tumour field is not compromised as a result.

Two cases are presented of bilateral conductive deafness in siblings. An initial presumptive diagnosis of otosclerosis was made in the first case, that of a nine-year-old girl with a bilateral hearing loss of 45 dB. Exploratory tympanotomy revealed normal ossicles but the stapedius ‘tendon’ was found to be a solid bony bar fixing the stapes. Division of the ‘tendon’ resulted in normal ossicular mobility and return of hearing with closure of the air-bone gap. Identical ossification was found in her other ear, and some years later in both ears of one of her brothers. Similar surgery restored hearing successfully in each case. An acquired aetiology has been proposed in one of the three previously reported cases; this report, however, suggests the congenital nature of the anomaly. No previous cases have been described occurring in siblings.

Since the introduction of antibiotics for the treatment of suppurative otitis media the incidence of complications from this disease has been greatly diminished. Acute mastoiditis, resulting in the deep neck abscess known as Bezold's abscess, has become very rare. A case of Bezold's abscess is presented with special reference to the clinical presentation and pathogenesis of this now uncommon condition. The variations in the routes of spread of the abscess in the fascial planes of the neck are described in detail. The difference between what is known today as a Bezold's abscess and the abscess that Bezold described in the early part of this century are presented.

The administration of antibiotics in otitis media alters the natural course of the disease process. If the antibiotics used are inappropriate, or if dosage or duration of treatment is inadequate, an imminent intracranial complication may be masked.

A case of latent mastoiditis presenting with Pott's puffy tumour is described.

A patient with neurofibromatosis two (NF2) presented with bilateral acoustic neuroma. Pre-operative audiometry revealed a dead right ear and severe left-sided sensorineural hearing loss. Following surgical removal of the larger right acoustic neuroma we have documented a sensorineural improvement of 45 dB in the contralateral ear on pure tone audiometry, which as far as the authors are aware has not previously been described.

Nasopharyngeal carcinoma hs been reported to have a higher incidence of distant metastases as compared to other head and neck cancers. Distant metastases of nasopharyngeal catcinoma has been reported in the bones, lungs, liver, distant lymph nodes, brain and porta hepatis. This report presents a case of nasopharyngeal carcinoma with secondaries in the extradural space at the thoracic level of the spinal cord which hitherto has been an unreported site.

The impaction of a cannabis-filled condom in the upper oesophagus of a 28-year-old prisoner is reported. The history was deceptive and smoking and drug abuse denied. The ENT surgeon being unaware of the identity of the drug faced tackling a possibly lethal foreign body, technically difficult to remove by the usual forceps method. (The Dormier basket is recommended for this task but we were unable to try it). Passage of the condom into the stomach occurred during attempted removal and its further progress was uneventful, indicating that gastroscopic removal of cannabis is unncessary unless obstructive symptoms occur.